Individual
NICOLE FANTONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
20 HAMPTON WAY, BLDG#1A, WAKEFIELD, RI 02879-2553
(401) 783-7009
(401) 789-3909
Mailing address
20 HAMPTON WAY STE 1A, WAKEFIELD, RI 02879-2554
(401) 783-7009
(401) 789-3909
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODTG00535
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316030125
—
RI
Enumeration date
10/02/2006
Last updated
09/21/2022
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