Provider Demographics
NPI:1265938179
Name:MODERN EYES LLC
Entity type:Organization
Organization Name:MODERN EYES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:VINCENZO
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIANFRANCESCO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-729-0200
Mailing Address - Street 1:145 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-4107
Mailing Address - Country:US
Mailing Address - Phone:401-729-0200
Mailing Address - Fax:401-729-0222
Practice Address - Street 1:145 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861
Practice Address - Country:US
Practice Address - Phone:401-524-4025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-01
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1447633060Medicaid