Provider Demographics
NPI:1083802938
Name:PLAINFIELD VISION CARE CENTER, INC.
Entity Type:Organization
Organization Name:PLAINFIELD VISION CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:MARANDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-564-2709
Mailing Address - Street 1:10 NORWICH RD.
Mailing Address - Street 2:P.O. BOX 545
Mailing Address - City:CENTRAL VILLAGE
Mailing Address - State:CT
Mailing Address - Zip Code:06332-0545
Mailing Address - Country:US
Mailing Address - Phone:860-564-2709
Mailing Address - Fax:860-564-4347
Practice Address - Street 1:10 NORWICH RD.
Practice Address - Street 2:
Practice Address - City:CENTRAL VILLAGE
Practice Address - State:CT
Practice Address - Zip Code:06332-0545
Practice Address - Country:US
Practice Address - Phone:860-564-2709
Practice Address - Fax:860-564-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U38463Medicare UPIN
CT4856950001Medicare NSC
D100000026Medicare PIN