Provider Demographics
NPI:1629032743
Name:IRELAND, JANE (OD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:IRELAND
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 1:615 GREENWICH AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1882
Mailing Address - Country:US
Mailing Address - Phone:401-244-5186
Mailing Address - Fax:401-396-2393
Practice Address - Street 1:615 GREENWICH AVE STE 10
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1882
Practice Address - Country:US
Practice Address - Phone:401-244-5186
Practice Address - Fax:401-396-2393
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002440152W00000X
RIODTA00526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJI68035Medicaid
RIU400249225Medicare PIN
RI007059707Medicare PIN