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General NPI Number Information
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NPI Number | 1548540438
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Entity Type | Individual
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Provider Name | MARK LIBASSI DO
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Gender | Male
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 04/08/2019
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Provider Practice Location Address
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Address Line | 1395 ATWOOD AVE STE 103
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City | JOHNSTON
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State | RI
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Zip | 02919-4930
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Country | US
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Telephone | 401-943-4330
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Fax | 401-943-4331
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Provider Business Mailing Address
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Address Line | 1450 ATWOOD AVENUE
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City | JOHNSTON
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State | RI
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Zip | 02919-4840
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Country | US
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Telephone | 401-943-4330
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Fax | 401-943-4331
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 113
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License Number State | RI
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