Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | RI0077 | RI |
NPI | 1174893507 |
---|---|
Provider Name | Mr. Eugene L. Folgo JR. |
First Address | Cranston, RI 02920-2823 |
Second Address | Cranston, RI 02920-2823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2012 |
Last Update Date | 02/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1639219330 | STRAND OPTICAL NPI (01) | RI |
9009839 | (05) | RI |