PROVIDENCE OPTICIANS DESIGNER EYEWEAR INC NPI 1790923605

NPI Information

NPI: 1790923605
Provider Name: PROVIDENCE OPTICIANS DESIGNER EYEWEAR INC

Former Legal Business Name: PROVIDENCE OPTICIANS INC

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
3510 12TH ST NE
WASHINGTON, DC
ZIP 20017
Phone: (202) 526-0300
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PROVIDENCE OPTICIANS DESIGNER EYEWEAR INC is an eyewear supplier in Washington, DC. The provider is an organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. PROVIDENCE OPTICIANS DESIGNER EYEWEAR INC NPI is 1790923605. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Providence Opticians Inc.

The provider's business location address is:

3510 12TH ST NE
WASHINGTON, DC
ZIP 20017-544
Phone: (202) 526-0300
Fax: (202) 526-0233

The provider's authorized official is Kyle E. Winslow .
The authorized official title is President and has the following contact phone number (202) 462-0055.

The enumeration date for this NPI number is 1/30/2009 and was last updated on 1/24/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332H00000X	Eyewear Supplier				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	016707300	MEDICAID	DISTRICT OF COLUMBIA
2	1538298906	OTHER	DISTRICT OF COLUMBIA	BLOCK VISION
3	61444	OTHER	DISTRICT OF COLUMBIA	DAVIS VISION
4	0732620001	MEDICARE UPIN	DISTRICT OF COLUMBIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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