Healthcare Provider Details

I. General information

NPI: 1942366737
Provider Name (Legal Business Name): KOCH EYE SURGICENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 QUAKER LN
WARWICK RI
02886-0103
US

IV. Provider business mailing address

566 TOLL GATE RD
WARWICK RI
02886-2716
US

V. Phone/Fax

Practice location:
  • Phone: 401-384-6537
  • Fax: 401-384-6541
Mailing address:
  • Phone: 401-738-4800
  • Fax: 401-738-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberFAS101016
License Number StateRI

VIII. Authorized Official

Name: MR. PETER A KOCH
Title or Position: CEO
Credential:
Phone: 401-738-4800