MEDICARE: SOUTH COUNTY EYE PHYSICIANS AND SURGEONS 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	207W00000X	Ophthalmology Physician		RI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CE6120	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4425631	OTHER		AETNA NON HMO
2	324	OTHER	RI	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0459676	OTHER		AETNA HMO
6	1998	OTHER		NEIGHBORHOOD HEALTH
7	R001038	OTHER		TRICARE

General Provider Information

NPI Number	:	1457306151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COUNTY EYE PHYSICIANS AND SURGEONS INC

Provider Business Mailing Address
First Line	:	65 BOSTON NECK ROAD
Second Line	:	SOUTH COUNTY EYE PHYSICIANS AND SURGEONS INC
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5704
Country	:	US
Telephone Number	:	401-294-4506
Fax Number	:	401-295-8870

Provider Business Practice Location Address
First Line	:	65 BOSTON NECK ROAD
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5704
Country	:	US
Telephone Number	:	401-294-4506
Fax Number	:	401-295-8870

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	DR. THOMAS J COGHLIN
Credential	:	MD
Telephone Number	:	401-294-4506

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/06/2010

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