=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477767630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEWPORT OPTICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1002 BROAD ST SUITE 7
-----------------------------------------------------
City | CENTRAL FALLS
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02863-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-723-0083
-----------------------------------------------------
Fax | 401-722-4950
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1002 BROAD ST SUITE 7
-----------------------------------------------------
City | CENTRAL FALLS
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02863-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-723-0083
-----------------------------------------------------
Fax | 401-722-4950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SAFA F WAGDI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 401-723-0083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | RI 93
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------