Provider Demographics
NPI:1811948193
Name:IACOBBO, ALERINO M (OD)
Entity type:Individual
Prefix:DR
First Name:ALERINO
Middle Name:M
Last Name:IACOBBO
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TILLINGHAST RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1504
Mailing Address - Country:US
Mailing Address - Phone:401-578-9809
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:891 WESTMINSTER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4020
Practice Address - Country:US
Practice Address - Phone:401-331-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00348152W00000X
MA2975152W00000X
RIODTG00555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T53723Medicare UPIN