Provider Demographics
NPI:1407853997
Name:BLODGETT, PAMELA J (OD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:BLODGETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1120 TOLL GATE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-0648
Mailing Address - Country:US
Mailing Address - Phone:401-822-2020
Mailing Address - Fax:401-823-5852
Practice Address - Street 1:1120 TOLLGATE ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-822-2020
Practice Address - Fax:401-823-5852
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00417152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0129360001OtherMEDCIARE DME
RI999995218OtherVISION SERVICE PLANS
RI9007934Medicaid
RI9924-6OtherBLUE CROSS/SHIELD
RI203400OtherBLUE CHIP
RI2816OtherNEIGHBORHOOD HEALTH
RI2816OtherNEIGHBORHOOD HEALTH
RI9924-6OtherBLUE CROSS/SHIELD
RIT90310Medicare UPIN