Provider Demographics
NPI:1437290889
Name:THE EYEGLASS STORE INC
Entity Type:Organization
Organization Name:THE EYEGLASS STORE INC
Other - Org Name:FAMILY EYE CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-723-9540
Mailing Address - Street 1:2 DEXTER ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-2991
Mailing Address - Country:US
Mailing Address - Phone:401-723-9540
Mailing Address - Fax:401-725-6583
Practice Address - Street 1:2 DEXTER ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-2991
Practice Address - Country:US
Practice Address - Phone:401-723-9540
Practice Address - Fax:401-725-6583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7959-2OtherBLUE CROSS
RIFE00663Medicaid
RIFE00663Medicaid