Provider Demographics
NPI:1265604862
Name:TOLL GATE VISION, LTD
Entity type:Organization
Organization Name:TOLL GATE VISION, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLODGETT
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR
Authorized Official - Phone:401-822-2020
Mailing Address - Street 1:1120 TOLL GATE RD STE C
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-0690
Mailing Address - Country:US
Mailing Address - Phone:401-822-2020
Mailing Address - Fax:401-823-5852
Practice Address - Street 1:1120 TOLL GATE RD STE C
Practice Address - Street 2:SUITE C
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0648
Practice Address - Country:US
Practice Address - Phone:401-822-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI003091OtherBLUE CHIP
RI9924-6OtherBLUE CROSS/SHIELD
RI9009924Medicaid
RI9924-6OtherBLUE CROSS/SHIELD
RI0129360001Medicare NSC