MEDICARE: CROCE AND PUGLIESE VISION CARE

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	ODTG00474	RI

General Provider Information

NPI Number	:	1376579821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROCE AND PUGLIESE VISION CARE

Provider Business Mailing Address
First Line	:	622 GEORGE WASHINGTON HWY
Second Line	:	LINCOLN MALL
City	:	LINCOLN
State	:	RI
Zip	:	02865-4211
Country	:	US
Telephone Number	:	401-333-0550
Fax Number	:	401-312-0083

Provider Business Practice Location Address
First Line	:	622 GEORGE WASHINGTON HWY
Second Line	:	LINCOLN MALL
City	:	LINCOLN
State	:	RI
Zip	:	02865-4211
Country	:	US
Telephone Number	:	401-333-0550
Fax Number	:	401-312-0083

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. JOHN ROBERT PUGLIESE
Credential	:	OD
Telephone Number	:	401-333-0550

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	12/01/2008

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