Provider Demographics
NPI:1376547851
Name:JENNINGS, DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:JENNINGS
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 1:19 CARONIA ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4333
Mailing Address - Country:US
Mailing Address - Phone:401-450-5263
Mailing Address - Fax:401-942-1783
Practice Address - Street 1:12 SMITH AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1767
Practice Address - Country:US
Practice Address - Phone:401-949-1616
Practice Address - Fax:401-942-0952
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4390152W00000X
RIODTA00508152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA469916OtherTUFTS PROVIDER #
MA0700215Medicaid
MAAA15972OtherHARVARD PILGRIM
MA4390OtherTPA OPTOMETRY LICENSE #
MAW16381OtherBCBS MA
MA4390OtherTPA OPTOMETRY LICENSE #
MAU92656Medicare UPIN