Provider Demographics
NPI:1891822797
Name:WATERMAN EYE CARE, INC.
Entity Type:Organization
Organization Name:WATERMAN EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-295-7339
Mailing Address - Street 1:426 SCRABBLETOWN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3649
Mailing Address - Country:US
Mailing Address - Phone:401-295-7339
Mailing Address - Fax:401-295-7311
Practice Address - Street 1:426 SCRABBLETOWN RD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3649
Practice Address - Country:US
Practice Address - Phone:401-295-7339
Practice Address - Fax:401-295-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG-397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003840Medicaid
RI2200506OtherUNITED HEALTHCARE
RI003167OtherBLUE CHIP
RI27923-5OtherBLUE CROSS BLUE SHIELD
RI021362703OtherVISION SERVICE PLAN
RI9003840Medicaid
RI9003840Medicaid
RI003167OtherBLUE CHIP