Provider Demographics
NPI:1376547851
Name:JENNINGS, DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:JENNINGS
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 1:19 CARONIA ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4333
Mailing Address - Country:US
Mailing Address - Phone:401-450-5263
Mailing Address - Fax:401-942-1783
Practice Address - Street 1:1180 FALL RIVER AVE
Practice Address - Street 2:NEXT TO WAL-MART VISION CENTER
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-5906
Practice Address - Country:US
Practice Address - Phone:508-680-6732
Practice Address - Fax:508-916-4327
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4390OtherTPA OPTOMETRY LICENSE #
MA469916OtherTUFTS PROVIDER #
MAW16381OtherBCBS MA
MAAA15972OtherHARVARD PILGRIM
MA0700215Medicaid
MA4390OtherTPA OPTOMETRY LICENSE #
MAU92656Medicare UPIN