Individual
MARK DERESIENSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
20 HAMPTON WAY, BLDG#1A, WAKEFIELD, RI 02879-2553
(401) 783-7009
(401) 789-3909
Mailing address
175 PARAMOUNT DR, SUITE 203, RAYNHAM, MA 02767-1065
(774) 320-3040
(508) 910-2204
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODTG00475
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7006708
—
RI
Enumeration date
10/02/2006
Last updated
05/04/2017
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