NPIMap

Organization Active NPI

Providence Opticians Designer Eyewear Inc

  • Eyewear Supplier
  • Washington, DC
National Provider Identifier
1790923605
Registry record updated Jan 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
PROVIDENCE OPTICIANS DESIGNER EYEWEAR INC
Practice address
3510 12TH St NE
Washington, DC 20017-2544
Phone
(202) 526-0300
Fax
(202) 526-0233
NPI assigned
Jan 30, 2009
Last updated
Jan 24, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2013

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

Authorized official

Name
Kyle E. Winslow, OPTICIANNPI 1881931954
Title
President
Phone
(202) 462-0055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

3510 12TH St NE
Washington, DC 20017-2544

Mailing address

3510 12TH St NE
Washington, DC 20017-2544
Phone (202) 526-0300

Other identifiers 3

IdentifierTypeStateIssuer
016707300MedicaidDC
1538298906OtherDCBLOCK VISION
61444OtherDCDAVIS VISION

Other names 1

  • Providence Opticians Inc Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Providence Opticians Designer Eyewear Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3510 12th St NE
Washington, DC 20017
Phone (202) 526-0300

3610 12th St NE
Washington, DC 20017

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358985600000",
    "number": "1790923605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3510 12TH ST NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172544",
            "telephone_number": "202-526-0300",
            "fax_number": "202-526-0233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 12TH ST NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172544",
            "telephone_number": "202-526-0300",
            "fax_number": "202-526-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE OPTICIANS DESIGNER EYEWEAR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-30",
        "last_updated": "2013-01-24",
        "status": "A",
        "authorized_official_last_name": "WINSLOW",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "202-462-0055",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016707300",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLOCK VISION",
            "identifier": "1538298906",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "61444",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Opticians Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; 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.