Provider Demographics
NPI:1457306151
Name:SOUTH COUNTY EYE PHYSICIANS AND SURGEONS INC
Entity Type:Organization
Organization Name:SOUTH COUNTY EYE PHYSICIANS AND SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:COGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-294-4506
Mailing Address - Street 1:65 BOSTON NECK ROAD
Mailing Address - Street 2:SOUTH COUNTY EYE PHYSICIANS AND SURGEONS INC
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5704
Mailing Address - Country:US
Mailing Address - Phone:401-294-4506
Mailing Address - Fax:401-295-8870
Practice Address - Street 1:65 BOSTON NECK ROAD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5704
Practice Address - Country:US
Practice Address - Phone:401-294-4506
Practice Address - Fax:401-295-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4425631OtherAETNA NON HMO
RI324OtherBLUE CROSS BLUE SHIELD
CE6120OtherRAILROAD MEDICARE
RISC00221Medicaid
0459676OtherAETNA HMO
1998OtherNEIGHBORHOOD HEALTH
R001038OtherTRICARE
=========OtherCIGNA
=========OtherVISION SERVICE PLAN
CE6120OtherRAILROAD MEDICARE
1998OtherNEIGHBORHOOD HEALTH