| Organization Name: | WICKFORD OPTICAL, LLC |
| NPI Number: | 1295953768 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOMENIC A COPPOLINO (PARTNER) |
| Mailing Address: | 7805 Post Rd North Kingstown |
| State: | RI US |
| Postal Code: | 028524405 |
| Phone Number: | 4012941010 |
| Fax Number: | 4012952050 |
| NPI Enumeration Date: | 04/23/2007 |
| NPI Last Update Date: | 03/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | ODTG 00369 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | RI |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |