Provider Demographics
NPI:1700279486
Name:FELICIA DONNOLO O.D., P. C. OPTICIANS OF BAY RIDGE
Entity type:Organization
Organization Name:FELICIA DONNOLO O.D., P. C. OPTICIANS OF BAY RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNOLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-238-3937
Mailing Address - Street 1:8721 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5109
Mailing Address - Country:US
Mailing Address - Phone:718-238-3937
Mailing Address - Fax:718-238-1091
Practice Address - Street 1:8721 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5109
Practice Address - Country:US
Practice Address - Phone:718-238-3937
Practice Address - Fax:718-238-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT0048941332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10-3050624OtherIMDIVIDUAL NPI