Basic Information
Provider Information
NPI: 1003298506
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCARAMUZZI
FirstName: JARED
MiddleName: JAMES
NamePrefix: DR.
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 355 ROBIN HOLLOW RD
Address2:  
City: WEST GREENWICH
State: RI
PostalCode: 028172141
CountryCode: US
TelephoneNumber: 4013975862
FaxNumber:  
Practice Location
Address1: 891 WESTMINSTER ST
Address2:  
City: PROVIDENCE
State: RI
PostalCode: 029034020
CountryCode: US
TelephoneNumber: 4013317850
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/22/2015
LastUpdateDate: 08/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000XODTG00619RIY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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