Provider Demographics
NPI:1073380267
Name:OCEAN STATE OPTICAL
Entity Type:Organization
Organization Name:OCEAN STATE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:N
Authorized Official - Last Name:MASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-424-9411
Mailing Address - Street 1:100 FEDERAL WAY
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-4637
Mailing Address - Country:US
Mailing Address - Phone:401-424-9411
Mailing Address - Fax:
Practice Address - Street 1:100 FEDERAL WAY
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-4637
Practice Address - Country:US
Practice Address - Phone:401-424-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier