Healthcare Provider Details

I. General information

NPI: 1467563676
Provider Name (Legal Business Name): B. DEAN NARDIS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4461 E. MAIN ST.
BELLEVILLE PA
17004-9266
US

IV. Provider business mailing address

344 HICKORY LN
BELLEVILLE PA
17004-8930
US

V. Phone/Fax

Practice location:
  • Phone: 717-329-6588
  • Fax:
Mailing address:
  • Phone: 717-329-6588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000679
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: