Provider Demographics
NPI:1285899278
Name:ARENA-BROOKS, JULIE (RO)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ARENA-BROOKS
Suffix:
Gender:F
Credentials:RO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6060
Mailing Address - Country:US
Mailing Address - Phone:401-943-4700
Mailing Address - Fax:401-943-4707
Practice Address - Street 1:1265 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6060
Practice Address - Country:US
Practice Address - Phone:401-943-4700
Practice Address - Fax:401-943-4707
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-19
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI0264332H00000X
RI264156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician