Healthcare Provider Details

I. General information

NPI: 1407853997
Provider Name (Legal Business Name): PAMELA J BLODGETT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 TOLLGATE ROAD SUITE C
WARWICK RI
02886
US

IV. Provider business mailing address

1120 TOLL GATE RD SUITE C
WARWICK RI
02886-0648
US

V. Phone/Fax

Practice location:
  • Phone: 401-822-2020
  • Fax: 401-823-5852
Mailing address:
  • Phone: 401-822-2020
  • Fax: 401-823-5852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTA00417
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: