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General NPI Number Information
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NPI Number | 1437232246
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Entity Type | Individual
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Provider Name | CLYDE E HAWORTH
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 10/28/2011
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Provider Practice Location Address
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Address Line | 2190 MENDON RD
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City | CUMBERLAND
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State | RI
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Zip | 02864-3805
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Country | US
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Telephone | 401-333-0090
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Fax | 401-333-0490
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Provider Business Mailing Address
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Address Line | 2190 MENDON RD
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City | CUMBERLAND
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State | RI
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Zip | 02864-3805
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Country | US
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Telephone | 401-333-0090
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Fax | 401-333-0490
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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 | ODTG495
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License Number State | RI
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