Healthcare Provider Details

I. General information

NPI: 1720539240
Provider Name (Legal Business Name): KOCH EYE ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 CASS AVE UNIT 1
WOONSOCKET RI
02895-4712
US

IV. Provider business mailing address

51 STATE RD
DARTMOUTH MA
02747-3319
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-2511
  • Fax: 401-769-7696
Mailing address:
  • Phone: 774-320-3040
  • Fax: 508-910-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: COREY B WESTERFELD
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 508-994-1400