Provider Demographics
NPI:1316073596
Name:SPINO OPTICIANS
Entity type:Organization
Organization Name:SPINO OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED OPTICIANS
Authorized Official - Prefix:
Authorized Official - First Name:LUCIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINO
Authorized Official - Suffix:
Authorized Official - Credentials:RO
Authorized Official - Phone:401-353-2010
Mailing Address - Street 1:1543 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:N PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-2943
Mailing Address - Country:US
Mailing Address - Phone:401-353-2010
Mailing Address - Fax:401-353-0380
Practice Address - Street 1:1543 SMITH ST
Practice Address - Street 2:
Practice Address - City:N PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-2943
Practice Address - Country:US
Practice Address - Phone:401-353-2010
Practice Address - Fax:401-353-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI135332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9009770Medicaid
RI9009770Medicaid