Provider Demographics
NPI:1891893277
Name:RAGOSTA-MAZZA, NANCY (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:RAGOSTA-MAZZA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3227
Mailing Address - Country:US
Mailing Address - Phone:401-521-0102
Mailing Address - Fax:401-521-0102
Practice Address - Street 1:1500 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3227
Practice Address - Country:US
Practice Address - Phone:401-521-0102
Practice Address - Fax:401-521-0102
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODT423152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI902817Medicaid
RIU26290Medicare UPIN
RI419020817Medicare ID - Type Unspecified