Provider Demographics
NPI:1518367937
Name:RHODE EYELAND LLC
Entity Type:Organization
Organization Name:RHODE EYELAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOISVERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-262-0042
Mailing Address - Street 1:74 FRENCHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-1758
Mailing Address - Country:US
Mailing Address - Phone:401-886-4349
Mailing Address - Fax:
Practice Address - Street 1:74 FRENCHTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-1758
Practice Address - Country:US
Practice Address - Phone:401-262-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty