Provider Demographics
NPI:1952540676
Name:JEFFREY P. MAINOLFI,O.D.,INC.
Entity Type:Organization
Organization Name:JEFFREY P. MAINOLFI,O.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAINOLFI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-937-1124
Mailing Address - Street 1:1000 E PULASKI HWY
Mailing Address - Street 2:VISION CENTER
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6306
Mailing Address - Country:US
Mailing Address - Phone:410-620-5251
Mailing Address - Fax:410-620-5307
Practice Address - Street 1:1000 E PULASKI HWY
Practice Address - Street 2:VISION CENTER
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6306
Practice Address - Country:US
Practice Address - Phone:410-620-5251
Practice Address - Fax:410-620-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1370152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU62520 MDMedicare UPIN
MDU62520Medicare UPIN