Provider Demographics
NPI:1225207038
Name:PAUL A DECESARE O
Entity Type:Organization
Organization Name:PAUL A DECESARE O
Other - Org Name:DECESARE EYE ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DECESARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-331-4475
Mailing Address - Street 1:354 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1434
Mailing Address - Country:US
Mailing Address - Phone:401-331-4475
Mailing Address - Fax:401-273-5742
Practice Address - Street 1:354 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1434
Practice Address - Country:US
Practice Address - Phone:401-331-4475
Practice Address - Fax:401-273-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPC03311Medicaid
RI1705OtherNHP
RI0631570001Medicare NSC
007003070Medicare PIN
RI1705OtherNHP