Provider Demographics
NPI:1013968379
Name:REMSBECKER, STEPHEN A (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:REMSBECKER
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 1:224 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3555
Mailing Address - Country:US
Mailing Address - Phone:401-438-2445
Mailing Address - Fax:401-438-2447
Practice Address - Street 1:224 WATERMAN AVE E
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914
Practice Address - Country:US
Practice Address - Phone:401-438-2445
Practice Address - Fax:401-438-2447
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00375152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
001863OtherBL CHIP
2200176OtherU H CARE
RI98502OtherBLUE CROSS
RISR06877Medicaid
RI419009850Medicare PIN
001863OtherBL CHIP
RI0681520002Medicare NSC