Provider Demographics
NPI:1790702710
Name:ROBERT J MANOLI OD AND ASSOCIATES PC
Entity Type:Organization
Organization Name:ROBERT J MANOLI OD AND ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MANOLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-465-7552
Mailing Address - Street 1:3159 RT. 9 SOUTH
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 RT. 9 SOUTH
Practice Address - Street 2:WALMART VISION CENTER
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA44427OtherDAVIS VISION
PA117672OtherHIGHMARK BLUE SHIELD
PA117672OtherHIGHMARK BLUE SHIELD
PA44427OtherDAVIS VISION