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General NPI Number Information
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NPI Number | 1437290889
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Entity Type | Organization
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Legal Business Name | THE EYEGLASS STORE INC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 2 DEXTER ST
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City | PAWTUCKET
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State | RI
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Zip | 02860-2991
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Country | US
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Telephone | 401-723-9540
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Fax | 401-725-6583
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Provider Business Mailing Address
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Address Line | 2 DEXTER ST
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City | PAWTUCKET
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State | RI
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Zip | 02860-2991
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Country | US
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Telephone | 401-723-9540
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Fax | 401-725-6583
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JONATHAN D KAPLAN
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Credential | OD
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Telephone | 401-723-9540
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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 | ODTG00494
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License Number State | RI
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