Provider Demographics
NPI:1417176504
Name:STEVEN DILIBERO OPTICIANS
Entity Type:Organization
Organization Name:STEVEN DILIBERO OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGESTERED OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DILIBERO
Authorized Official - Suffix:
Authorized Official - Credentials:RO
Authorized Official - Phone:401-353-9020
Mailing Address - Street 1:1920 MINERAL SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3742
Mailing Address - Country:US
Mailing Address - Phone:401-353-9020
Mailing Address - Fax:
Practice Address - Street 1:1920 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3742
Practice Address - Country:US
Practice Address - Phone:401-353-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI122332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007933Medicaid
RI2109020OtherUNITED HEALTH CARE
RI4219 2857OtherNEIGHBORHOOD HEALTH
RIRI0122OtherEYEMED