Provider Demographics
NPI:1366599441
Name:CHILD, A. ROBERT JR (OD)
Entity type:Individual
Prefix:DR
First Name:A.
Middle Name:ROBERT
Last Name:CHILD
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 RESERVOIR AVE
Mailing Address - Street 2:LL5
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6068
Mailing Address - Country:US
Mailing Address - Phone:401-943-8151
Mailing Address - Fax:401-943-1324
Practice Address - Street 1:1150 RESERVOIR AVE
Practice Address - Street 2:LL5
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6068
Practice Address - Country:US
Practice Address - Phone:401-943-8151
Practice Address - Fax:401-943-1324
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003250Medicaid
RIGC00269Medicaid
RI1295856540OtherORGANIZATION NPI
RIT53762Medicare UPIN
RIGC00269Medicaid
RI0399810001Medicare NSC
RI419002602Medicare PIN