Provider Demographics
NPI:1447402821
Name:OSMANSKI, JAD (OD)
Entity Type:Individual
Prefix:DR
First Name:JAD
Middle Name:
Last Name:OSMANSKI
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 1:1971 MINERAL SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3723
Mailing Address - Country:US
Mailing Address - Phone:401-232-0941
Mailing Address - Fax:401-231-1454
Practice Address - Street 1:1971 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3723
Practice Address - Country:US
Practice Address - Phone:401-232-0941
Practice Address - Fax:401-231-1454
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4874152W00000X
RIODTG00529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI002434603Medicare PIN