1467563676 NPI number — DR. B. DEAN NARDIS O.D.

Table of content: DR. B. DEAN NARDIS O.D. (NPI 1467563676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467563676 NPI number — DR. B. DEAN NARDIS O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NARDIS
Provider First Name:
B.
Provider Middle Name:
DEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

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:
1467563676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
344 HICKORY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17004-8930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-329-6588
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4461 E. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17004-9266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-329-6588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006

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:  OEG000679 , 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: 37415 . This is a "AVESIS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 49451 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 24830 . This is a "STARMOUNT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0892436 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 710862119 . This is a "NVA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 09389 . This is a "SPECTERA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 22802 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 42379 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 919526 . This is a "BLOCK VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 37444 . This is a "AVESIS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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