Provider Demographics
NPI:1871695460
Name:FORMAN, DENNIS STEVEN (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:STEVEN
Last Name:FORMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1500 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-1547
Mailing Address - Country:US
Mailing Address - Phone:401-769-3310
Mailing Address - Fax:401-769-4147
Practice Address - Street 1:481 CLINTON ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3214
Practice Address - Country:US
Practice Address - Phone:401-769-3310
Practice Address - Fax:401-769-4147
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODT00339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3236942/7082094PINOtherAETNA
RI203181OtherBLUE CHIP
RI9855-7OtherBLUE SHIELD BLUE CROSS
RI27568/10350OtherNEIGHBORHOOD HEALTH PLAN
RI131028/168605OtherCOLE VISION
RI2200924OtherUNITED HEALTHCARE
RI9009855Medicaid
RI2200924OtherUNITED HEALTHCARE
RI27568/10350OtherNEIGHBORHOOD HEALTH PLAN