Provider Demographics
NPI:1265444335
Name:ESTRADA, ROLANDO
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ROLAND
Other - Middle Name:
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:7665 POST RD
Mailing Address - Street 2:SUITE #8
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852
Mailing Address - Country:US
Mailing Address - Phone:401-295-1334
Mailing Address - Fax:401-295-1358
Practice Address - Street 1:7665 POST RD
Practice Address - Street 2:SUITE #8
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852
Practice Address - Country:US
Practice Address - Phone:401-295-1334
Practice Address - Fax:401-295-1358
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI0449152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI79864OtherBLUE CROSS
RI9007914Medicaid
RI2200320OtherUNITED HEALTH CARE
RI79864OtherBLUE CROSS