Provider Demographics
NPI:1073613741
Name:CORVESE, JOHN S (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:CORVESE
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 1:868 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4414
Mailing Address - Country:US
Mailing Address - Phone:401-942-9933
Mailing Address - Fax:401-270-2491
Practice Address - Street 1:868 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4414
Practice Address - Country:US
Practice Address - Phone:401-942-9933
Practice Address - Fax:401-270-2491
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007909Medicaid
RI1073613741Medicaid
RI9007909Medicaid