Provider Demographics
NPI:1164568531
Name:RISPOLI, ALESSI A (OD)
Entity Type:Individual
Prefix:DR
First Name:ALESSI
Middle Name:A
Last Name:RISPOLI
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 1:70 CORPORATE PL
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-6274
Mailing Address - Country:US
Mailing Address - Phone:401-846-1620
Mailing Address - Fax:401-841-5500
Practice Address - Street 1:70 CORPORATE PL
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6274
Practice Address - Country:US
Practice Address - Phone:401-846-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG467152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007911Medicaid
RI7911-8OtherBLUE CROSS
RI22-00260OtherUNITED HEALTH CARE
RI200342OtherBLUE CHIP
RI9007911Medicaid