Provider Demographics
NPI:1235356908
Name:KOMARI, MAROUN ADIB
Entity Type:Individual
Prefix:MR
First Name:MAROUN
Middle Name:ADIB
Last Name:KOMARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6060
Mailing Address - Country:US
Mailing Address - Phone:401-336-3937
Mailing Address - Fax:401-336-3939
Practice Address - Street 1:1265 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6060
Practice Address - Country:US
Practice Address - Phone:401-336-3937
Practice Address - Fax:401-336-3939
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOP 00334156FX1800X
MA5703156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician