Provider Demographics
NPI:1174509921
Name:BOIVIN, JOSEPH A (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:BOIVIN
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 1:1820 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-4625
Mailing Address - Country:US
Mailing Address - Phone:401-624-6672
Mailing Address - Fax:401-624-4769
Practice Address - Street 1:1820 MAIN RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-4625
Practice Address - Country:US
Practice Address - Phone:401-624-6672
Practice Address - Fax:401-624-4769
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI400630OtherBLUE CHIP
RI5761621OtherAETNA
RI26587OtherRI BLUE SHIELD
RI0859OtherNHP RI GROUP #
RI759127OtherTUFTS
RI2814OtherNEIGHBORHOOD RI
RI6915366OtherCIGNA
RIAA6678OtherHARVARD
RI2200041OtherUNITED
RI603940OtherTUFTS - GROUP #
RI9007778Medicaid
RI410040026OtherRAILROAD MEDICARE
RI9001520Medicaid
RI9001520Medicaid
RI0859OtherNHP RI GROUP #
RI2814OtherNEIGHBORHOOD RI