Provider Demographics
NPI:1255485009
Name:ANDOLINA, PATRICIA J (OD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:ANDOLINA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:PERSIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:28 NOBLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559
Mailing Address - Country:US
Mailing Address - Phone:585-352-5498
Mailing Address - Fax:
Practice Address - Street 1:3180 LATTA RD
Practice Address - Street 2:SUITE #300
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3087
Practice Address - Country:US
Practice Address - Phone:585-663-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT0043841152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P010004384OtherBLUE CROSS & BLUE SHIELD
101963CSOtherPREFERRED CARE
101963CSOtherPREFERRED CARE