Provider Demographics
NPI:1134759350
Name:RAPHAEL CORP
Entity type:Organization
Organization Name:RAPHAEL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BASANT
Authorized Official - Middle Name:T
Authorized Official - Last Name:SIDHOM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-472-9424
Mailing Address - Street 1:1565 POST RD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-5949
Mailing Address - Country:US
Mailing Address - Phone:401-472-9424
Mailing Address - Fax:401-472-9423
Practice Address - Street 1:1565 POST RD UNIT 5
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-5949
Practice Address - Country:US
Practice Address - Phone:603-418-4956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty