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General NPI Number Information
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NPI Number | 1265938179
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Entity Type | Organization
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Legal Business Name | MODERN EYES LLC
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Dates
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Enumeration Date | 04/01/2018
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 145 NEWPORT AVE
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City | PAWTUCKET
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State | RI
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Zip | 02861
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Country | US
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Telephone | 401-524-4025
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Fax |
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Provider Business Mailing Address
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Address Line | 145 NEWPORT AVE
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City | PAWTUCKET
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State | RI
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Zip | 02861-4107
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Country | US
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Telephone | 401-729-0200
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Fax | 401-729-0222
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | VINCENZO L GIANFRANCESCO
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Credential | OD
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Telephone | 401-729-0200
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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 | ODTG00620
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License Number State | RI
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