Healthcare Provider Details

I. General information

NPI: 1871895110
Provider Name (Legal Business Name): VIKRANT DONTHAMSETTI D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 TOLL GATE RD
WARWICK RI
02886-2716
US

IV. Provider business mailing address

PO BOX 308
NEENAH WI
54957-0308
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-4800
  • Fax: 401-738-8153
Mailing address:
  • Phone: 920-886-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDO00748
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number68195-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: