Provider Demographics
NPI:1295860419
Name:PRO VISION INC. DBA FEROCIOUS EYES OPTICAL
Entity Type:Organization
Organization Name:PRO VISION INC. DBA FEROCIOUS EYES OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:RO
Authorized Official - Phone:401-295-1334
Mailing Address - Street 1:7665 POST RD
Mailing Address - Street 2:
Mailing Address - City:N KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3220
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:
Practice Address - City:N KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3220
Practice Address - Country:US
Practice Address - Phone:401-295-1334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI114332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI407390OtherBLUECHIP
RIPV13450Medicaid