Provider Demographics
NPI:1659482685
Name:TAMBOE, WILLIAM (DISPENSING OPTICIAN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:TAMBOE
Suffix:
Gender:M
Credentials:DISPENSING OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2703
Mailing Address - Country:US
Mailing Address - Phone:401-351-2769
Mailing Address - Fax:
Practice Address - Street 1:919 SMITH ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-2703
Practice Address - Country:US
Practice Address - Phone:401-351-2769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOP00075156FX1800X
MA1332156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOP00075OtherSTATE LICENSE
MA1332OtherSTATE LICENSE