Provider Demographics
NPI:1306833868
Name:SANTOS, STEVEN W (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:W
Last Name:SANTOS
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 1:248 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-8134
Mailing Address - Country:US
Mailing Address - Phone:401-726-2929
Mailing Address - Fax:401-729-1054
Practice Address - Street 1:248 BROAD ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-8134
Practice Address - Country:US
Practice Address - Phone:401-726-2929
Practice Address - Fax:401-729-1054
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3543152W00000X
RIODTG428152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7003178Medicaid
MA03000080Medicaid
MA460258Medicare PIN
RI007001337Medicare PIN
RI7003178Medicaid