Provider Demographics
NPI:1538693023
Name:O'NEIL, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:O'NEIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:YOASH
Other - Middle Name:R
Other - Last Name:ENZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:120 DUDLEY ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2436
Mailing Address - Country:US
Mailing Address - Phone:401-274-4464
Mailing Address - Fax:
Practice Address - Street 1:120 DUDLEY ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2436
Practice Address - Country:US
Practice Address - Phone:401-274-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07280207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007056071Medicare PIN
RIE90352Medicare UPIN