Provider Demographics
NPI:1730813114
Name:FAVRE, AARON BARAK (OD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:BARAK
Last Name:FAVRE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:280 LOCUST GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-1061
Mailing Address - Country:US
Mailing Address - Phone:316-727-4907
Mailing Address - Fax:
Practice Address - Street 1:1013 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-5134
Practice Address - Country:US
Practice Address - Phone:401-942-4087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00733152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist