Michael Raymond Iannuccilli, OD
Individual provider Active NPI Optometrist · Wakefield, RI
NPI 1972554053 · NPPES record last updated Sep 4, 2007
Key facts
- NPI
- 1972554053
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- ODTA00323 (RI)
- Practice address
- 553 Kingstown Rd
Optometric Providers of Rhode Island, Inc
Wakefield, RI 02879-3600 - Phone
- (401) 782-2100
- Fax
- (401) 848-7402
- NPI assigned
- May 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optometric Providers of Rhode Island, Inc | Optometrist | Past | Accepting new patients |
| Optometric Providers of Rhode Island, Inc | Optometrist | Past | Accepting new patients |
| Optometric Providers of Rhode Island, Inc | Optometrist | Past | Accepting new patients |
| Optometric Providers of Rhode Island, Inc | Optometrist | Past | Accepting new patients |
| Optometric Providers of Rhode Island, Inc | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | ODTA00323 | RI | Yes |
Addresses
Primary practice location
553 Kingstown Rd
Optometric Providers of Rhode Island, Inc
Wakefield, RI 02879-3600
Mailing address
2921 Erie Blvd East
Syracuse, NY 13224
Phone (315) 445-7465
Other providers in Wakefield, RI
- Humayun Gazder
- Bailey Hunter
- Joseph Hunyady-Manes
- Joseph G Hyde
- Jill Susan Iacono
- Savannah Iasimone
- Innovative Works
- Elizabeth Bogardus Ison
- Sherry Jackson
- Susan Charlotte Jacobsen
All providers in Wakefield, 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 Sep 4, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.