Provider Demographics
NPI:1568613784
Name:JENNINGS EYECARE INC.
Entity Type:Organization
Organization Name:JENNINGS EYECARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, JENNINGS EYECARE INC.
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-450-5263
Mailing Address - Street 1:19 CARONIA ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4333
Mailing Address - Country:US
Mailing Address - Phone:401-450-5263
Mailing Address - Fax:508-916-4327
Practice Address - Street 1:1180 FALL RIVER AVE
Practice Address - Street 2:NEXT TO WAL-MART VISION CENTER
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-5906
Practice Address - Country:US
Practice Address - Phone:508-680-6732
Practice Address - Fax:508-916-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29174-1OtherBC/BS
MAW17532Medicare PIN
RI29174-1OtherBC/BS