Provider Demographics
NPI:1316581424
Name:DR. DEGIULIO & ASSOCIATES INC
Entity Type:Organization
Organization Name:DR. DEGIULIO & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGIULIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-474-4963
Mailing Address - Street 1:13 CAPRI DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3328
Mailing Address - Country:US
Mailing Address - Phone:401-474-4963
Mailing Address - Fax:
Practice Address - Street 1:400 BALD HILL ROAD STE 163
Practice Address - Street 2:WARWICK MALL
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-738-9866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007169Medicaid