Provider Demographics
NPI:1164830675
Name:CHACE, KIM J (RDO)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:J
Last Name:CHACE
Suffix:
Gender:F
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 POST RD
Mailing Address - Street 2:BENNY'S PLAZA SUITE 111
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3400
Mailing Address - Country:US
Mailing Address - Phone:401-885-2166
Mailing Address - Fax:401-885-2201
Practice Address - Street 1:5600 POST RD
Practice Address - Street 2:BENNY'S PLAZA
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3400
Practice Address - Country:US
Practice Address - Phone:401-885-2166
Practice Address - Fax:401-885-2201
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI212156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician