Mandalay Optical Labs, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODTA00491 Issued in RI

Legal business name

MANDALAY OPTICAL LABS, LLC

Practice address

905 Westminster St
Providence, RI 02903-4020

Phone

(401) 331-7850

Fax

(401) 331-7850

NPI assigned

Dec 21, 2017

Last updated

Dec 21, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Scott A Colonna, ODNPI 1538169784

Title

Manager

Phone

(401) 331-7850

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Scott A Colonna, O.D.

  • Optometrist
  • Providence, RI
  • NPI 1538169784
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513814400000",
    "number": "1396251740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 WESTMINSTER ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034020",
            "telephone_number": "401-331-7850",
            "fax_number": "401-331-7850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 WESTMINSTER ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034020",
            "telephone_number": "401-331-7850",
            "fax_number": "401-331-7850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDALAY OPTICAL LABS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-21",
        "last_updated": "2017-12-21",
        "status": "A",
        "authorized_official_last_name": "COLONNA",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "401-331-7850",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "RI",
            "license": "ODTA00491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538169784",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nickolas Mancini, MD
• Rhonda Marie Manco, RN, BSN
• Joan Teresa Mancuso, MA
• Keiry Alejandra Mancuso
• Kaushik Mandal, MD
• Cheryl Mandel, BCBA
• Kaavya Mandi, DO
• Daniel Manfra, M.D.
• Elizabeth Anne Mangiameli, LICSW
• Ashley Mangione, PTA

• Optometrist in Providence, RI
• Providers in Providence, RI by specialty
• Optometrist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.