Provider Demographics
NPI:1669658274
Name:CHRISTOPHER C WAY MD PROFESSIONAL SERVICE CORPORATION
Entity Type:Organization
Organization Name:CHRISTOPHER C WAY MD PROFESSIONAL SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CARR
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-942-0210
Mailing Address - Street 1:PO BOX 6300
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-6300
Mailing Address - Country:US
Mailing Address - Phone:401-942-0210
Mailing Address - Fax:401-943-4240
Practice Address - Street 1:1150 RESERVOIR AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6068
Practice Address - Country:US
Practice Address - Phone:401-942-0210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMDD6752207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI189000595Medicare PIN