Provider Demographics
NPI:1285652974
Name:MANOLI, ROBERT JOSEPH (OD OPTOMETRIST)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:MANOLI
Suffix:
Gender:M
Credentials:OD OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3159 ROUTE 9 S
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242-1012
Mailing Address - Country:US
Mailing Address - Phone:609-465-7552
Mailing Address - Fax:609-465-7704
Practice Address - Street 1:3159 ROUTE 9 S
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1012
Practice Address - Country:US
Practice Address - Phone:609-465-7552
Practice Address - Fax:609-465-7704
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG001354152W00000X
NJ27OA00446400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA44427OtherDAVIS VISION
PA117672OtherHIGHMARK BLUE SHIELD
MA117672Medicare ID - Type Unspecified
U24403Medicare UPIN