Provider Demographics
NPI:1639111271
Name:GINSBERG, LAWRENCE T (OD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:T
Last Name:GINSBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1716
Mailing Address - Country:US
Mailing Address - Phone:401-431-2929
Mailing Address - Fax:401-431-2031
Practice Address - Street 1:2224 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1716
Practice Address - Country:US
Practice Address - Phone:401-431-2929
Practice Address - Fax:401-431-2031
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOD00499152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI522108187-05OtherTRICARE
RI7908-8OtherBLUE CROSS
RI003200OtherBLUE CHIP
RI22-00206OtherUNITED HEALTH
RI9007908Medicaid
RIT53317Medicare UPIN
RI7908-8OtherBLUE CROSS