Deresienski, Mark
Deresienski, Mark is an individual health care provider with primary practice located at 20 Hampton Way Bldg#1A, Wakefield RI 02879-2553. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Deresienski, Mark can be contacted via phone (401) 783-7009.Contact Information
Primary practice address
20 Hampton Way Bldg#1A
Wakefield RI 02879-2553
Phone: (401) 783-7009
Fax: (401) 789-3909
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | ODTG00475 | Rhode Island |
Profile Details
| NPI number | 1952494759 |
|---|---|
| LBN Legal business name | Deresienski, Mark |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 2nd, 2006 |
| Last updated | May 4th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952494759 | NPPES |
| Rhode Island | MEDICAID | 7006708 |
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