Healthcare Provider Details

I. General information

NPI: 1790702710
Provider Name (Legal Business Name): ROBERT J MANOLI OD AND ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3159 RT. 9 SOUTH WALMART VISION CENTER
RIO GRANDE NJ
08242-1012
US

IV. Provider business mailing address

3159 RT. 9 SOUTH
RIO GRANDE NJ
08242-1012
US

V. Phone/Fax

Practice location:
  • Phone: 609-465-7552
  • Fax: 609-465-7704
Mailing address:
  • Phone: 609-465-7552
  • Fax: 609-465-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JOSEPH MANOLI
Title or Position: PRESIDENT
Credential: OD
Phone: 609-465-7552