Healthcare Provider Details

I. General information

NPI: 1790398022
Provider Name (Legal Business Name): VICTORIA ROSE BRANCA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2374 POST RD STE 104
WARWICK RI
02886-2270
US

IV. Provider business mailing address

70 TRAYMORE ST
CRANSTON RI
02920-4368
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-0098
  • Fax: 401-921-0073
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00703
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: