Individual provider Active NPI

Sarah Wise, OD

  • Optometrist
  • Providence, RI
National Provider Identifier
1780107607
Registry record updated Apr 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
RI-ODTG00638 Issued in RI
Practice address
623 Atwells Ave
Providence, RI 02909-7403
Phone
(401) 273-7100
NPI assigned
Jul 23, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X RI-ODTG00638 RI Primary

Addresses

Primary practice location

623 Atwells Ave
Providence, RI 02909-7403

Mailing address

623 Atwells Ave
Providence, RI 02909-7403

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, RI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181009003082 MA Practitioner - Optometry 5496007072 Reassigns benefits to 1 organization
I20200420001236 RI Practitioner - Optometry 5496007072 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
20/20 Vision Care, Inc.Group PAC ID 0547210452, 4 clinicians

Practice addresses (Care Compare)

375 Metacom Ave
Bristol, RI 02809-5179
Phone (401) 253-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RI-ODTG00638RIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Jewell Eye Inc Optometrist CurrentSince Aug 5, 2018 Accepting new patients
20/20 Vision Care, Inc. Optometrist CurrentSince Mar 23, 2020 Accepting new patients

Locations

601 Donald Lynch Blvd
Ste 151
Marlborough, MA 01752
Phone (508) 481-8279

375 Metacom Ave
Bristol, RI 02809
Phone (401) 253-2020

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1500768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586217600000",
    "number": "1780107607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 ATWELLS AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029097403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 ATWELLS AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029097403",
            "telephone_number": "401-273-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "SARAH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-23",
        "last_updated": "2020-04-07",
        "certification_date": "2020-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "RI",
            "license": "RI-ODTG00638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.