Provider Demographics
NPI:1528206042
Name:MICHAEL E. DOBROWOLSKI OD,PA
Entity Type:Organization
Organization Name:MICHAEL E. DOBROWOLSKI OD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:RANFOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-669-0447
Mailing Address - Street 1:395 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-4841
Mailing Address - Country:US
Mailing Address - Phone:603-669-0447
Mailing Address - Fax:603-669-0850
Practice Address - Street 1:395 SO MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102
Practice Address - Country:US
Practice Address - Phone:603-669-0447
Practice Address - Fax:603-669-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0794152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0009984Medicare PIN
NH6211290001Medicare NSC