Provider Demographics
NPI:1992157564
Name:BOBOLA, HELENA (OD)
Entity type:Individual
Prefix:DR
First Name:HELENA
Middle Name:
Last Name:BOBOLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HELEN
Other - Middle Name:HUANG
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 848448
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8448
Mailing Address - Country:US
Mailing Address - Phone:800-340-0129
Mailing Address - Fax:105-246-5872
Practice Address - Street 1:169 JENNIFER RD STE D
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4170
Practice Address - Country:US
Practice Address - Phone:410-224-0021
Practice Address - Fax:410-224-2098
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2537152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD13838402OtherCAQH ID #
MDTA2537OtherSTATE LICENSE