Elizabeth Wassenaar, OD
Individual provider Active NPI Optometrist · Providence, RI
NPI 1972025187 · NPPES record last updated Mar 12, 2026
Key facts
- NPI
- 1972025187
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- ODTG00654 (RI)
- Practice address
- 150 E Manning St
Providence, RI 02906 - Phone
- (401) 272-2020
- Fax
- (401) 421-5979
- NPI assigned
- Jul 10, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Prytula Eye Associates Inc
Eyediology Vision LLC
Practice addresses (Care Compare)
1193 Tiogue Ave
Coventry, RI 02816-6170
Phone (401) 823-8200
245 Waterman St
Suite 309
Providence, RI 02906-5215
Phone (401) 227-2188
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180719003468 | RI | Practitioner - Optometry | 6608123773 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ODTG00654 | RI | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prytula Eye Associates Inc | Optometrist | Current |
Accepting new patients |
| Eyediology Vision, LLC | Optometrist | Current |
Accepting new patients |
| 4Sight Eyewear Inc. | Optometrist | Current |
Accepting new patients |
| Mark G. Blasbalg OD Inc | Optometrist | Past |
Accepting new patients |
Locations
1193 Tiogue Ave
Coventry, RI 02816
Phone (401) 823-8200
245 Waterman St
Ste 309
Providence, RI 02906
Phone (401) 227-2188
385 Mendon Rd
Woonsocket, RI 02895
Phone (401) 762-4473
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Optometrist | 152W00000X | ODTG00654 | RI | Yes |
Addresses
Primary practice location
150 E Manning St
Providence, RI 02906
Mailing address
246 Power St Apt 1
Providence, RI 02906-3953
Phone (312) 301-7446
Other practice location 1
385 Mendon Rd
Woonsocket, RI 02895-2477
Phone (401) 762-4473
Other practice location 2
1601 Brenner Ave
Salisbury, NC 28144-2515
Phone (704) 638-3825
Other practice location 3
245 Waterman St Ste 309
Providence, RI 02906-5215
Phone (401) 227-2188
Other providers in Providence, RI
- Scott Warren
- Sarita S. Warrier
- Ruth J Wartenberg
- Washington Park Citizens Association, Inc.
- Elisa Marie Wasilewski
- Meredith Caroline Wasserman
- Courtney Wassmer
- Waterman Dental LLC
- Alexandra Waters
- Henri Paul Wathieu
All providers in Providence, RI · Optometrist in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.