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General NPI Number Information
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NPI Number | 1669658274
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER C WAY MD PROFESSIONAL SERVICE CORPORATION
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 1150 RESERVOIR AVE SUITE 204
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City | CRANSTON
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State | RI
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Zip | 02920-6068
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Country | US
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Telephone | 401-942-0210
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6300
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City | PROVIDENCE
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State | RI
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Zip | 02940-6300
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Country | US
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Telephone | 401-942-0210
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Fax | 401-943-4240
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER CARR WAY
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Credential |
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Telephone | 401-942-0210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MDD6752
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License Number State | RI
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