Provider Demographics
NPI:1548240146
Name:MARANDOLA, HOPE BERNARD (OD)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:BERNARD
Last Name:MARANDOLA
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:P.O. BOX 545
Mailing Address - Street 2:
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
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004124343Medicaid
CT2V3741OtherHEALTHNET
CT2311OtherEYE MED
50890OtherDAVIS VISION
CT090002311CT03OtherANTHEM BCBS
CT558369OtherCONNECTICARE
50890OtherDAVIS VISION
CT2V3741OtherHEALTHNET
CT004124343Medicaid