Provider Demographics
NPI:1003298506
Name:SCARAMUZZI, JARED JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:JAMES
Last Name:SCARAMUZZI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-7121
Mailing Address - Country:US
Mailing Address - Phone:401-521-3606
Mailing Address - Fax:401-453-3288
Practice Address - Street 1:1277 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7121
Practice Address - Country:US
Practice Address - Phone:401-521-3606
Practice Address - Fax:401-453-3288
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1003298506Medicaid