MEDICARE: OPHTHALMOLOGY INC

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	156FX1800X	Optician

General Provider Information

NPI Number	:	1194169227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMOLOGY INC

Provider Business Mailing Address
First Line	:	150 E MANNING ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02906-5109
Country	:	US
Telephone Number	:	401-272-2020
Fax Number	:	401-421-5979

Provider Business Practice Location Address
First Line	:	55 VILLAGE SQUARE DR
Second Line	:	BUILDING 24
City	:	SOUTH KINGSTOWN
State	:	RI
Zip	:	02879-8274
Country	:	US
Telephone Number	:	401-272-2020
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT BAHR
Credential	:	MD
Telephone Number	:	401-272-2020

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	04/19/2013

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