Provider Demographics
NPI:1184769010
Name:ATLANTIC FAMILY EYE CARE INC
Entity type:Organization
Organization Name:ATLANTIC FAMILY EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-765-5430
Mailing Address - Street 1:2345 MENDON RD
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6164
Mailing Address - Country:US
Mailing Address - Phone:401-765-5430
Mailing Address - Fax:401-765-8175
Practice Address - Street 1:2345 MENDON RD
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-6164
Practice Address - Country:US
Practice Address - Phone:401-765-5430
Practice Address - Fax:401-765-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2680OtherNEIGHBORHOOD HEALTH
RIAF34660Medicaid
RI4343470001Medicare NSC
RI419094925Medicare PIN