Healthcare Provider Details

I. General information

NPI: 1699914697
Provider Name (Legal Business Name): DR. SANDRA BWINT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 KINGS HWY E
HADDONFIELD NJ
08033-1905
US

IV. Provider business mailing address

206 KINGS HWY E
HADDONFIELD NJ
08033-1905
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-6930
  • Fax: 856-429-6930
Mailing address:
  • Phone: 856-429-6930
  • Fax: 856-429-6930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27TO00005600
License Number StateNJ

VIII. Authorized Official

Name: DR. SANDRA BWINT
Title or Position: OWNER/OPTOMERIST
Credential: O.D.
Phone: 856-429-6930