Provider Demographics
NPI:1053505263
Name:OPTOMETRIC PROVIDERS OF RHODE ISLAND, INC
Entity Type:Organization
Organization Name:OPTOMETRIC PROVIDERS OF RHODE ISLAND, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:IANNUCCILLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-782-2100
Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:C/O EMPIRE VISION CENTER, INC
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1430
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:45 NEWPORT AVE STE A
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-2070
Practice Address - Country:US
Practice Address - Phone:401-434-9870
Practice Address - Fax:401-434-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty