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General NPI Number Information
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NPI Number | 1679875900
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Entity Type | Organization
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Legal Business Name | EYE STOP, INC.
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | 41 SANDERSON RD 203
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City | SMITHFIELD
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State | RI
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Zip | 02917-2602
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Country | US
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Telephone | 401-349-4791
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Fax | 401-349-4795
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Provider Business Mailing Address
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Address Line | 41 SANDERSON RD 203
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City | SMITHFIELD
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State | RI
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Zip | 02917-2602
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Country | US
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Telephone | 401-349-4791
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Fax | 401-349-4795
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ROBERT PUGLIESE
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Credential | OD
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Telephone | 401-349-4791
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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 | ODTG00474
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License Number State | RI
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