Provider Demographics
NPI:1942325287
Name:DONNA GAVIN DBA DONNA GAVIN OD
Entity Type:Organization
Organization Name:DONNA GAVIN DBA DONNA GAVIN OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROP
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-423-3605
Mailing Address - Street 1:17 INTREPID LN
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835-1830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 INTREPID LN
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02835-1830
Practice Address - Country:US
Practice Address - Phone:401-423-3605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty