Organization
WICKFORD OPTICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOMENIC A COPPOLINO O.D. (PARTNER)
(401) 294-1010
Entity
Organization
Contact information
Practice address
7805 POST RD, NORTH KINGSTOWN, RI 02852-4405
(401) 294-1010
(401) 295-2050
Mailing address
7805 POST RD, NORTH KINGSTOWN, RI 02852-4405
(401) 294-1010
(401) 295-2050
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
ODTG 00369
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
WO16877
—
RI
Enumeration date
04/23/2007
Last updated
03/02/2010
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