Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | OP00096 | RI |
NPI | 1134299381 |
---|---|
Provider Name | Richard A Crute |
First Address | Warwick, RI 02886-2716 |
Second Address | Warwick, RI 02886-2716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 31/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9009881 | (05) | RI |