Provider Demographics
NPI:1669804753
Name:PRYTULA, LIANE CARLEY (OD)
Entity type:Individual
Prefix:
First Name:LIANE
Middle Name:CARLEY
Last Name:PRYTULA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 TIOGUE AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6122
Mailing Address - Country:US
Mailing Address - Phone:401-823-8200
Mailing Address - Fax:401-826-8708
Practice Address - Street 1:1193 TIOGUE AVE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6170
Practice Address - Country:US
Practice Address - Phone:401-823-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist