Provider Demographics
NPI:1861478620
Name:BOIVIN, LORI B (OD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:B
Last Name:BOIVIN
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 1:150 E MANNING ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5109
Mailing Address - Country:US
Mailing Address - Phone:401-272-2020
Mailing Address - Fax:401-421-5979
Practice Address - Street 1:150 E MANNING ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5109
Practice Address - Country:US
Practice Address - Phone:401-272-2020
Practice Address - Fax:401-421-5979
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRIOD438152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2200287OtherUNITED
RI004621OtherBLUE CHIP
RI26587OtherRI BLUE SHIELD
RI2824OtherNEIGHBORHOOD RI
RI603940OtherTUFTS GROUP #
RI9210534OtherCIGNA
RI773061OtherTUFTS
RI410040028OtherRAILROAD MEDICARE
RI7003033Medicaid
RI0859OtherNHP RI GROUP #
RI9001520Medicaid
RI5058609OtherAETNA
RIAA3297OtherHARVARD
RIU35442Medicare UPIN
RI410040028OtherRAILROAD MEDICARE
RI603940OtherTUFTS GROUP #