Healthcare Provider Details

I. General information

NPI: 1598215436
Provider Name (Legal Business Name): MARIANNA KONRADI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 WALTON DR STE A6
BREWER ME
04412-1001
US

IV. Provider business mailing address

24 WALTON DR STE A6
BREWER ME
04412-1001
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-1492
  • Fax: 844-801-2454
Mailing address:
  • Phone: 207-200-1492
  • Fax: 844-801-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9076T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: