Basic Information
| Provider Information | |||||||||
| NPI: | 1922661685 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLLEGE HILL EYE AND OPTICAL INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | C/O 891 WESTMINSTER STREET | ||||||||
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| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013317850 | ||||||||
| FaxNumber: | 4012744739 | ||||||||
| Practice Location | |||||||||
| Address1: | 295 S MAIN ST | ||||||||
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| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029032910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018312015 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2019 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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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 | ||||||||
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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.