Healthcare Provider Details

I. General information

NPI: 1235534272
Provider Name (Legal Business Name): KOCH EYE ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 CASS AVE UNIT 1
WOONSOCKET RI
02895-4712
US

IV. Provider business mailing address

618 TOLL GATE RD
WARWICK RI
02886-2717
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-2511
  • Fax:
Mailing address:
  • Phone: 401-738-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCELLO CELENTANO
Title or Position: CEO
Credential:
Phone: 401-738-4800