Provider Demographics
NPI:1477767630
Name:NEWPORT OPTICAL INC
Entity Type:Organization
Organization Name:NEWPORT OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAFA
Authorized Official - Middle Name:F
Authorized Official - Last Name:WAGDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-723-0083
Mailing Address - Street 1:1002 BROAD ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-1500
Mailing Address - Country:US
Mailing Address - Phone:401-723-0083
Mailing Address - Fax:401-722-4950
Practice Address - Street 1:1002 BROAD ST
Practice Address - Street 2:SUITE 7
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-1500
Practice Address - Country:US
Practice Address - Phone:401-723-0083
Practice Address - Fax:401-722-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI 93156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI295628OtherID BLUE CROSS&BLUE SHIELD
RINO 00725Medicaid
MAZBH770OtherBLUE CROSS&BLUE SHIELD
RI409033OtherID BLUE CHIP OF RI
RINO 00725Medicaid