Provider Demographics
NPI:1376054445
Name:I FOR AN EYE, LLC
Entity Type:Organization
Organization Name:I FOR AN EYE, LLC
Other - Org Name:DECESARE EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-837-3708
Mailing Address - Street 1:363 HAWKINS ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2306
Mailing Address - Country:US
Mailing Address - Phone:508-837-3708
Mailing Address - Fax:
Practice Address - Street 1:354 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1434
Practice Address - Country:US
Practice Address - Phone:401-331-4475
Practice Address - Fax:401-273-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U300416104OtherMEDICARE
RI1538685938Medicaid