Provider Demographics
NPI:1871543868
Name:EYE-SHOP INC
Entity type:Organization
Organization Name:EYE-SHOP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDREONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-351-6450
Mailing Address - Street 1:1524 ATWOOD AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-351-6450
Mailing Address - Fax:401-272-0388
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-351-6450
Practice Address - Fax:401-272-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0384870001Medicare NSC