Provider Demographics
NPI:1063852903
Name:PUGLIESE, DAVID THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:PUGLIESE
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 1:594 HARTFORD PIKE
Mailing Address - Street 2:
Mailing Address - City:N SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-1260
Mailing Address - Country:US
Mailing Address - Phone:401-486-5143
Mailing Address - Fax:
Practice Address - Street 1:41 SANDERSON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2602
Practice Address - Country:US
Practice Address - Phone:401-349-4791
Practice Address - Fax:401-349-4795
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00602152W00000X
MA4968152W00000X
NY008104152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U400118440Medicare PIN