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General NPI Number Information
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NPI Number | 1376547851
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Entity Type | Individual
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Provider Name | DAVID JENNINGS O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 12 SMITH AVE
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City | GREENVILLE
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State | RI
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Zip | 02828-1767
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Country | US
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Telephone | 401-949-1616
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Fax | 401-942-0952
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Provider Business Mailing Address
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Address Line | 19 CARONIA ST
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City | CRANSTON
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State | RI
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Zip | 02920-4333
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Country | US
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Telephone | 401-450-5263
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Fax | 401-942-1783
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4390
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODTA00508
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License Number State | RI
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