Provider Demographics
NPI:1922195890
Name:CUMBERLAND FAMILY EYE CARE, LTD.
Entity Type:Organization
Organization Name:CUMBERLAND FAMILY EYE CARE, LTD.
Other - Org Name:EAST PROVIDENCE FAMILY EYE CARE, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-435-5555
Mailing Address - Street 1:250 WAMPANOAG TRL
Mailing Address - Street 2:SUITE 304
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2218
Mailing Address - Country:US
Mailing Address - Phone:401-435-5555
Mailing Address - Fax:401-431-5906
Practice Address - Street 1:250 WAMPANOAG TRAIL
Practice Address - Street 2:SUITE 304
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-2217
Practice Address - Country:US
Practice Address - Phone:401-435-5555
Practice Address - Fax:401-431-5906
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUMBERLAND FAMILY EYE CARE, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICF00226Medicaid
RIEP00226Medicaid
RI419007937Medicare PIN
RIEP00226Medicaid
RI0418000001Medicare NSC