MEDICARE: DR. DAVID JENNINGS O.D.

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	152W00000X	Optometrist	4390	MA
2	152W00000X	Optometrist	ODTA00508	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	469916	OTHER	MA	TUFTS PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AA15972	OTHER	MA	HARVARD PILGRIM
4	4390	OTHER	MA	TPA OPTOMETRY LICENSE #
5	W16381	OTHER	MA	BCBS MA

General Provider Information

NPI Number	:	1376547851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JENNINGS O.D.

Provider Business Mailing Address
First Line	:	19 CARONIA ST
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02920-4333
Country	:	US
Telephone Number	:	401-450-5263
Fax Number	:	401-942-1783

Provider Business Practice Location Address
First Line	:	12 SMITH AVE
Second Line	:
City	:	GREENVILLE
State	:	RI
Zip	:	02828-1767
Country	:	US
Telephone Number	:	401-949-1616
Fax Number	:	401-942-0952

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/15/2024

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Directions to “ DR. DAVID JENNINGS O.D.” Practice Location

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