Provider Demographics
NPI:1598215436
Name:KONRADI, MARIANNA (OD)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:
Last Name:KONRADI
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 1:4722 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4733
Mailing Address - Country:US
Mailing Address - Phone:325-704-8797
Mailing Address - Fax:844-801-2454
Practice Address - Street 1:4722 S 14TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4733
Practice Address - Country:US
Practice Address - Phone:325-704-8797
Practice Address - Fax:844-801-2454
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9076T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist