NPIMap

Organization Active NPI

Aeg Rhode Island Professional, PC

  • Optometrist
  • Pawtucket, RI
National Provider Identifier
1730898263
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
AEG RHODE ISLAND PROFESSIONAL, PC
Practice address
2 Dexter St
Pawtucket, RI 02860-2996
Phone
(401) 723-9540
Fax
(314) 741-4947
NPI assigned
Nov 23, 2022
Last updated
Apr 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Authorized official

Name
Jonathan Kaplan, ODNPI 1023077898
Title
Owner
Phone
(618) 462-9818

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

2 Dexter St
Pawtucket, RI 02860-2996

Mailing address

111 E 4TH St Ste 440
Alton, IL 62002-6206
Phone (618) 462-9818

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230303000711 RI Part B Supplier - Clinic/Group Practice 3870966369 Receives reassigned benefits from 10 practitioners
Practice locations: Providence, RI; Pawtucket, RI

National Provider Directory

National Provider Directory

Locations

2 Dexter St
Ste 3
Pawtucket, RI 02860

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1669161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743724800000",
    "number": "1730898263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 4TH ST STE 440",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026206",
            "telephone_number": "618-462-9818",
            "fax_number": "314-741-4947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 DEXTER ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028602996",
            "telephone_number": "401-723-9540",
            "fax_number": "314-741-4947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEG RHODE ISLAND PROFESSIONAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-23",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A",
        "authorized_official_last_name": "KAPLAN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-462-9818",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pawtucket, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.