Healthcare Provider Details

I. General information

NPI: 1043431042
Provider Name (Legal Business Name): DOUBLE VISION OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1168 WARWICK AVE
WARWICK RI
02888
US

IV. Provider business mailing address

1168 WARWICK AVE
WARWICK RI
02888
US

V. Phone/Fax

Practice location:
  • Phone: 401-463-7100
  • Fax:
Mailing address:
  • Phone: 401-463-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number156
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN LUCA SPAZIANO
Title or Position: PRESIDENT
Credential: OPTICIAN
Phone: 401-463-7100