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General NPI Number Information
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NPI Number | 1205098050
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OPTOMETRIST SERVICES INC
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 50 LOWER COLLEGE RD
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City | KINGSTON
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State | RI
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Zip | 02881
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Country | US
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Telephone | 401-874-4063
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Fax | 401-874-7559
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Provider Business Mailing Address
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Address Line | 50 LOWER COLLEGE RD
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City | KINGSTON
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State | RI
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Zip | 02881
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Country | US
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Telephone | 401-874-4063
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Fax | 401-874-7559
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Authorized Official
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Title or Position | OPTOMETRIST OWNER
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Name | DR. DAWN OSHEA MICHAEL
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Credential | OD
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Telephone | 401-874-4063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODT453
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License Number State | RI
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