Provider Demographics
NPI:1972618270
Name:ST VINCENT, WILLIAM W (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:W
Last Name:ST VINCENT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 AARON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1548
Mailing Address - Country:US
Mailing Address - Phone:401-253-4199
Mailing Address - Fax:
Practice Address - Street 1:375 METACOM AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-5179
Practice Address - Country:US
Practice Address - Phone:401-253-2020
Practice Address - Fax:401-253-3220
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7002697Medicaid
RI0219350001Medicare NSC
RI007002697Medicare PIN
RI7002697Medicaid