Provider Demographics
NPI:1811949886
Name:MOLINARI, ANTHONY ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ROBERT
Last Name:MOLINARI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 VINCENT RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536
Mailing Address - Country:US
Mailing Address - Phone:508-839-6723
Mailing Address - Fax:508-839-1087
Practice Address - Street 1:1 HOLLYWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536
Practice Address - Country:US
Practice Address - Phone:508-839-3616
Practice Address - Fax:508-839-1087
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0311243Medicaid
MA120058Medicare PIN
MA0311243Medicaid
MA120058Medicare ID - Type Unspecified