Provider Demographics
NPI:1497781827
Name:EDWARD J MCDONALD
Entity Type:Organization
Organization Name:EDWARD J MCDONALD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:RO
Authorized Official - Phone:401-738-6277
Mailing Address - Street 1:3466 W SHORE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-5035
Mailing Address - Country:US
Mailing Address - Phone:401-738-6277
Mailing Address - Fax:
Practice Address - Street 1:3466 W SHORE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-5035
Practice Address - Country:US
Practice Address - Phone:401-738-6277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRO00104332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2873-1OtherBLUE CROSS
RI29660OtherNEIGHBORHOOD HEALTH
RI207247OtherBLUE CHIP
RI2109056OtherUNITED HEALTH
RI8678001Medicaid
RI2109056OtherUNITED HEALTH