Provider Demographics
NPI:1063203529
Name:PANGBORN, JOSHUA ANTHONY (OD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ANTHONY
Last Name:PANGBORN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 CHARLESTOWN BEACH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-2447
Mailing Address - Country:US
Mailing Address - Phone:401-742-6400
Mailing Address - Fax:
Practice Address - Street 1:133 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-3511
Practice Address - Country:US
Practice Address - Phone:401-782-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICODTG00771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist