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  5. DONALD V. FARGNOLI, M.D., INC.

DONALD V. FARGNOLI, M.D., INC.

Company Details

Name: DONALD V. FARGNOLI, M.D., INC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Dissolved
Date of Organization in Rhode Island: 03 Sep 1985 (39 years ago)
Date of Dissolution: 30 Dec 2020 (4 years ago)
Date of Status Change: 30 Dec 2020 (4 years ago)
Identification Number: 000035715
ZIP code: 02911
County: Providence County
Principal Address: 1358 SMITH STREET, NORTH PROVIDENCE, RI, 02911, USA
Purpose: THE PROFESSIONAL PRACTICE OF MEDICINE(OPTHALMOLOGY)
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1245439561 2007-07-16 2008-06-05 1358 SMITH ST, NORTH PROVIDENCE, RI, 029113304, US 1358 SMITH ST, NORTH PROVIDENCE, RI, 029113304, US

Contacts
Phone +1 401-353-2525
Fax 4013536792

Authorized person
Name DR. DONALD VINCENT FARGNOLI
Role PRESIDENT
Phone 4013532525

Taxonomy
Taxonomy Code 207W00000X - Ophthalmology Physician
License Number 5736
State RI
Is Primary Yes

Other Provider Identifiers
Issuer HMO BLUE CHIP NEW ENGLAND
Number 000762
State RI
Issuer NEIGHBORHOOD HEALTH PLAN
Number 2879
State RI
Issuer MEDICAID
Number 9000077
State RI
Issuer NEIGHBORHOOD HEALTH PLAN
Number 0279
State RI
Issuer BLUE CHIP
Number 000762
State RI
Issuer BLUE SHIELD OF RHODE ISLA
Number 0000000077
State RI
Issuer BLUE CHIP FOR MEDICARE OP
Number 000762
State RI
Issuer RAILROAD MEDICARE
Number 180002352
State RI
Issuer TUFTS HEALTH PLAN
Number 728575
State RI
Issuer UNITED HEALTHCARE (INDIVI
Number 0800081
State RI
Issuer BLUE CHIP FOR MEDICARE
Number 000762
State RI
Issuer MEDICARE OF RHODE ISLAND
Number 189000077
State RI
Issuer BLUE CHIP FOR RITECARE
Number 000762
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DONALD V. FARGNOLI, M.D., INC. RETIREMENT PLAN 2022 050416237 2023-06-14 DONALD V. FARGNOLI, M.D., INC. 2
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4012255844
Plan sponsor’s address 158 RACQUET ROAD, JAMESTOWN, RI, 028352929
DONALD V. FARGNOLI, M.D., INC. RETIREMENT PLAN 2021 050416237 2022-03-18 DONALD V. FARGNOLI, M.D., INC. 12
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4012255844
Plan sponsor’s address 158 RACQUET ROAD, JAMESTOWN, RI, 028352929
DONALD V. FARGNOLI, M.D., INC. RETIREMENT PLAN 2020 050416237 2021-03-08 DONALD V. FARGNOLI, M.D., INC. 12
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4012255844
Plan sponsor’s address 158 RACQUET ROAD, JAMESTOWN, RI, 028352929
DONALD V. FARGNOLI, M.D., INC. RETIREMENT PLAN 2019 050416237 2020-05-28 DONALD V. FARGNOLI, M.D., INC. 12
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113347
DONALD V. FARGNOLI, M.D., INC. RETIREMENT PLAN 2018 050416237 2019-06-03 DONALD V. FARGNOLI, M.D., INC. 11
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113347
DONALD V. FARGNOLI, M.D., INC. RETIREMENT PLAN 2017 050416237 2018-05-10 DONALD V. FARGNOLI, M.D., INC. 12
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113347
DONALD V. FARGNOLI, M.D., INC. RETIREMENT PLAN 2017 050416237 2018-05-10 DONALD V. FARGNOLI, M.D., INC. 12
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113347
DONALD V. FARGNOLI, M.D., INC. RETIREMENT PLAN 2016 050416237 2017-06-19 DONALD V. FARGNOLI, M.D., INC. 11
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113347
DONALD V. FARGNOLI, M.D., INC. CASH BALANCE PLAN 2015 050416237 2016-12-19 DONALD V. FARGNOLI, M.D., INC. 0
File View Page
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113347

Plan administrator’s name and address
Administrator’s EIN 050416237
Plan administrator’s name DONALD V. FARGNOLI, M.D., INC.
Plan administrator’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304
Administrator’s telephone number 4013532525
DONALD V. FARGNOLI, M.D., INC. RETIREMENT PLAN 2015 050416237 2016-08-11 DONALD V. FARGNOLI, M.D., INC. 12
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113347
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/10/07/20161007121935P030012939255001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113347

Plan administrator’s name and address
Administrator’s EIN 050416237
Plan administrator’s name DONALD V. FARGNOLI, M.D., INC.
Plan administrator’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304
Administrator’s telephone number 4013532525
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/10/13/20151013210226P040046974257001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113347

Plan administrator’s name and address
Administrator’s EIN 050416237
Plan administrator’s name DONALD V. FARGNOLI, M.D., INC.
Plan administrator’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304
Administrator’s telephone number 4013532525

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing DONALD V. FARGNOLI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/09/10/20150910063052P040015738941001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113347

Signature of
Role Plan administrator
Date 2015-09-10
Name of individual signing DONALD V. FARGNOLI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/14/20141014203220P040051018097001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029083304

Plan administrator’s name and address
Administrator’s EIN 050416237
Plan administrator’s name DONALD V. FARGNOLI, M.D., INC.
Plan administrator’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304
Administrator’s telephone number 4013532525

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing DONALD V. FARGNOLI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/06/20141006201535P030036200551001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029083304

Signature of
Role Plan administrator
Date 2014-10-06
Name of individual signing DONALD V. FARGNOLI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/08/20131008114654P040009760677001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029083304

Plan administrator’s name and address
Administrator’s EIN 050416237
Plan administrator’s name DONALD V. FARGNOLI, M.D., INC.
Plan administrator’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304
Administrator’s telephone number 4013532525

Signature of
Role Plan administrator
Date 2013-10-08
Name of individual signing DONALD V. FARGNOLI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/08/21/20130821082806P030005352596001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029083304

Signature of
Role Plan administrator
Date 2013-08-21
Name of individual signing DONALD V. FARGNOLI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/09/05/20120905082005P030046191874001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304

Plan administrator’s name and address
Administrator’s EIN 050416237
Plan administrator’s name DONALD V. FARGNOLI, M.D., INC.
Plan administrator’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304
Administrator’s telephone number 4013532525

Signature of
Role Plan administrator
Date 2012-09-05
Name of individual signing DONALD V. FARGNOLI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/10/15/20121015161251P030001419205001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304

Plan administrator’s name and address
Administrator’s EIN 050416237
Plan administrator’s name DONALD V. FARGNOLI, M.D., INC.
Plan administrator’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304
Administrator’s telephone number 4013532525

Signature of
Role Plan administrator
Date 2012-10-15
Name of individual signing DONALD V. FARGNOLI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/17/20111017105946P040051346631001.pdf
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304

Plan administrator’s name and address
Administrator’s EIN 050416237
Plan administrator’s name DONALD V. FARGNOLI, M.D., INC.
Plan administrator’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304
Administrator’s telephone number 4013532525

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing DONALD V. FARGNOLI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/09/22/20110922204256P030135080561001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304

Plan administrator’s name and address
Administrator’s EIN 050416237
Plan administrator’s name DONALD V. FARGNOLI, M.D., INC.
Plan administrator’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304
Administrator’s telephone number 4013532525

Signature of
Role Plan administrator
Date 2011-09-22
Name of individual signing DONALD V. FARGNOLI, M.D.
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 004
Effective date of plan 2007-01-01
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304

Plan administrator’s name and address
Administrator’s EIN 050416237
Plan administrator’s name DONALD V. FARGNOLI, M.D., INC.
Plan administrator’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 029113304
Administrator’s telephone number 4013532525

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing DONALD V. FARGNOLI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/05/03/20100503113923P040236408433001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1987-09-03
Business code 621111
Sponsor’s telephone number 4013532525
Plan sponsor’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 02908

Plan administrator’s name and address
Administrator’s EIN 050416237
Plan administrator’s name DONALD V. FARGNOLI, M.D., INC.
Plan administrator’s address 1358 SMITH STREET, NORTH PROVIDENCE, RI, 02908
Administrator’s telephone number 4013532525

Signature of
Role Plan administrator
Date 2010-05-03
Name of individual signing DONALD V. FARGNOLI
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ANTHONY M. GALLONE, JR. ESQ. Agent 7 WATERMAN AVENUE, NORTH PROVIDENCE, RI, 02911, USA

PRESIDENT

Name Role Address
DONALD V. FARGNOLI, M.D. PRESIDENT 1358 SMITH STREET NORTH PROVIDENCE, RI 02911 USA

Filings

Number Name File Date
202083045390 Articles of Dissolution 2020-12-30
202033529570 Annual Report 2020-01-31
201986713650 Annual Report 2019-02-14
201983492800 Statement of Change of Registered Office by the Registered Agent 2019-01-01
201855795440 Annual Report 2018-01-08
201746961550 Annual Report 2017-07-03
201601079910 Statement of Change of Registered Office by the Registered Agent 2016-06-27
201693467420 Annual Report 2016-02-29
201554071430 Annual Report 2015-01-22
201444925610 Statement of Change of Registered Office by the Registered Agent 2014-08-29

Related by officers

ANTHONY M. GALLONE, JR. ESQ.

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Related by address

No related companies by address

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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