MEDICARE: CHARLES FRANCIS LANZILLO JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	6503	RI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	180000279	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003611	OTHER	RI	BLUE CHIP
2	010025951CT01	OTHER	CT	BLUE SHIELD OF CT
3	180000279	OTHER		DMERC
4	031463	OTHER		HEALTHNET
5	000000002011	OTHER		NEIGHBORHOOD HEALTH PLAN
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	0800140	OTHER		UNITED HEALTH CARE
9	NLS024	OTHER		OXFORD
10	0000002064	OTHER	RI	BLUE SHIELD OF RI
11	AA33959	OTHER		HARVARD PILGRIM HEALTH

General Provider Information

NPI Number	:	1013945344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES FRANCIS LANZILLO JR.

Provider Business Mailing Address
First Line	:	17 WELLS ST
Second Line	:	SUITE 102
City	:	WESTERLY
State	:	RI
Zip	:	02891-2923
Country	:	US
Telephone Number	:	401-596-0339
Fax Number	:	401-596-3437

Provider Business Practice Location Address
First Line	:	17 WELLS ST
Second Line	:	SUITE 102
City	:	WESTERLY
State	:	RI
Zip	:	02891-2923
Country	:	US
Telephone Number	:	401-596-0339
Fax Number	:	401-596-3437

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/08/2007

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Directions to “ CHARLES FRANCIS LANZILLO JR. ” Practice Location

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