Provider Demographics
NPI:1376721381
Name:JOSEPH A BOIVIN O.D., LTD
Entity Type:Organization
Organization Name:JOSEPH A BOIVIN O.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOIVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-624-6672
Mailing Address - Street 1:1820 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-4625
Mailing Address - Country:US
Mailing Address - Phone:401-624-6672
Mailing Address - Fax:401-624-4769
Practice Address - Street 1:1820 MAIN RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-4625
Practice Address - Country:US
Practice Address - Phone:401-624-6672
Practice Address - Fax:401-624-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007778Medicaid
RI4316760001Medicare NSC
RI419007778Medicare UPIN