Provider Demographics
NPI:1902800592
Name:ANDOLINA, THOMAS A (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:ANDOLINA
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 1:325 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1723
Mailing Address - Country:US
Mailing Address - Phone:585-394-2020
Mailing Address - Fax:585-394-9261
Practice Address - Street 1:325 WEST ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1723
Practice Address - Country:US
Practice Address - Phone:585-394-2020
Practice Address - Fax:585-394-9261
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005260152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02305911Medicaid
NYU71897Medicare UPIN
NY02305911Medicaid