Provider Demographics
NPI:1518003904
Name:RISPOLI, KATHERINE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:RISPOLI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 E MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-4912
Mailing Address - Country:US
Mailing Address - Phone:401-846-1620
Mailing Address - Fax:401-841-5500
Practice Address - Street 1:58 E MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-4912
Practice Address - Country:US
Practice Address - Phone:401-846-1620
Practice Address - Fax:401-841-5500
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7975-2OtherBLUE CROSS
RI9007975Medicaid
RI003985OtherBLUE CHIP
RI22-00261OtherUNITED HEALTH CARE
RI22-00261OtherUNITED HEALTH CARE