| Name: | University Optometrist Services, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 16 Aug 2005 (19 years ago) |
| Date of Dissolution: | 04 Oct 2006 (18 years ago) |
| Date of Status Change: | 04 Oct 2006 (18 years ago) |
| Identification Number: | 000149955 |
| Purpose: | OPTOMETRY |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205098050 | 2008-07-01 | 2008-07-01 | 50 LOWER COLLEGE RD, KINGSTON, RI, 02881, US | 50 LOWER COLLEGE RD, KINGSTON, RI, 02881, US | |||||||||||||||||||||||||
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| Phone | +1 401-874-4063 |
| Fax | 4018747559 |
Authorized person
| Name | DR. DAWN OSHEA MICHAEL |
| Role | OPTOMETRIST OWNER |
| Phone | 4018744063 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | ODT453 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | 419002976 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| WILLIAM A. NARDONE | Agent | 53 HIGH STREET, WESTERLY, RI, 02891-, USA |
| Name | Role | Address |
|---|---|---|
| WILLIAM A NARDONE | INCORPORATOR | 53 HIGH STREET WESTERLY, RI 02891- USA |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
