Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | ODTG00619 | RI |
NPI | 1003298506 |
---|---|
Provider Name | Dr. Jared James Scaramuzzi |
First Address | Providence, RI 02903-4020 |
Second Address | Greenville, RI 02828-1487 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2015 |
Last Update Date | 05/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003298506 | (05) | RI |