Healthcare Provider Details

I. General information

NPI: 1598295057
Provider Name (Legal Business Name): JEFFREY G DEPAOLA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 TOLL GATE RD
WARWICK RI
02886-0648
US

IV. Provider business mailing address

1120 TOLL GATE RD
WARWICK RI
02886-0648
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00639
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: