Provider Demographics
NPI:1124474317
Name:SANTOS, MICHAEL C (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:SANTOS
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 VALLEY STREAM DRIVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864
Mailing Address - Country:US
Mailing Address - Phone:401-334-2818
Mailing Address - Fax:
Practice Address - Street 1:248 BROAD ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-8134
Practice Address - Country:US
Practice Address - Phone:401-726-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPPLIED FOR152W00000X
RIODTG00628152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist