Provider Demographics
NPI:1497016661
Name:SAMPALIS EYECARE PC
Entity Type:Organization
Organization Name:SAMPALIS EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAMPALIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-241-9188
Mailing Address - Street 1:24 SCARALIA RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921
Mailing Address - Country:US
Mailing Address - Phone:401-241-9188
Mailing Address - Fax:401-828-4240
Practice Address - Street 1:650 BALD HILL RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1863
Practice Address - Country:US
Practice Address - Phone:401-822-2050
Practice Address - Fax:401-822-2050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR MARIA SAMPALIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-05
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA4629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110079003AMedicaid
RIMS90656Medicaid
RIMS90656Medicaid