Individual
MR. ROBERT LEO BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
15 TOURO ST, NEWPORT, RI 02840-2912
(401) 846-0101
(401) 846-6161
Mailing address
15 TOURO ST, NEWPORT, RI 02840-2912
(401) 846-0101
(401) 846-6161
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
OP 00169
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000029104-0
BLUE SHIELD
RI
01
—
412086
BLUE CHIP
RI
Enumeration date
12/15/2006
Last updated
07/08/2007
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