1417203944 NPI number — DR. SANDRA K TRAVAGLIANTI O.D.

Table of content: DR. SANDRA K TRAVAGLIANTI O.D. (NPI 1417203944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417203944 NPI number — DR. SANDRA K TRAVAGLIANTI O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAVAGLIANTI
Provider First Name:
SANDRA
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

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:
1417203944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 JOYCE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROADVIEW HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44147-1433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-785-7492
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8934 DARROW RD
Provider Second Line Business Practice Location Address:
SPACE C104
Provider Business Practice Location Address City Name:
TWINSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44087-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-425-9830
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6164 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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