Provider Demographics
NPI:1902079841
Name:ENVISIONS EYECARE CENTERS INC
Entity Type:Organization
Organization Name:ENVISIONS EYECARE CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORVESE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-438-1166
Mailing Address - Street 1:1970 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1718
Mailing Address - Country:US
Mailing Address - Phone:401-438-1166
Mailing Address - Fax:401-438-1614
Practice Address - Street 1:1970 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1718
Practice Address - Country:US
Practice Address - Phone:401-438-1166
Practice Address - Fax:401-438-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007909Medicaid
RI4924480001Medicare NSC
RIT53701Medicare UPIN
RI9007909Medicaid