Individual
JESSICA MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1150 RESERVOIR AVE, CRANSTON, RI 02920-6068
(401) 943-8151
Mailing address
14 EATON ST, NORTH SMITHFIELD, RI 02896-7806
(401) 580-2488
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
4752
MA
152W00000X
Optometrist
Primary
ODTG00546
RI
Other
Enumeration date
12/22/2009
Last updated
12/22/2009
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