Basic Information
| Provider Information | |||||||||
| NPI: | 1073116240 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SMITHFIELD EYE & OPTICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 891 WESTMINSTER ST | ||||||||
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| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013317850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 PUTNAM PIKE STE 3 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028281487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4019497300 | ||||||||
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| ProviderEnumerationDate: | 11/19/2020 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | COLONNA | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4013317850 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.