Provider Demographics
NPI:1811987746
Name:KILE, JAY P (OD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:P
Last Name:KILE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:103 KING PHILLIP RD
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-5705
Mailing Address - Country:US
Mailing Address - Phone:401-821-2050
Mailing Address - Fax:401-821-2050
Practice Address - Street 1:650 BALD HILL RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1863
Practice Address - Country:US
Practice Address - Phone:401-821-2050
Practice Address - Fax:401-821-2050
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIODTA00483152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI419023274Medicare ID - Type Unspecified