Provider Demographics
NPI:1881811479
Name:EYES UNIQUE
Entity type:Organization
Organization Name:EYES UNIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:RO
Authorized Official - Phone:401-943-3937
Mailing Address - Street 1:1180 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-3148
Mailing Address - Country:US
Mailing Address - Phone:401-943-3937
Mailing Address - Fax:
Practice Address - Street 1:1180 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3148
Practice Address - Country:US
Practice Address - Phone:401-943-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOP115156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0683571Medicaid