1710289673 NPI number — SARAH BRUNO O.D.P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710289673 NPI number — SARAH BRUNO O.D.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SARAH BRUNO O.D.P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710289673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 THISTLE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-5627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-840-9705
Provider Business Mailing Address Fax Number:
610-558-7831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98 WILMINGTON W CHESTER PIKE
Provider Second Line Business Practice Location Address:
SUITE102
Provider Business Practice Location Address City Name:
CHADDS FORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19317-9010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-459-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNO
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/OPTOMETRIST
Authorized Official Telephone Number:
610-459-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG001785 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: YDK6 . This is a "MEDICARE GROUP SUFFIX" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3816083000 . This is a "PERSONAL CHOICE / KEYSTONE HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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