Healthcare Provider Details

I. General information

NPI: 1598387102
Provider Name (Legal Business Name): BRENDAN SEWALL CONNORS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 AIRPORT RD
HAZLE TOWNSHIP PA
18202-3320
US

IV. Provider business mailing address

4854 NOBLES POND DR NW
CANTON OH
44718-3846
US

V. Phone/Fax

Practice location:
  • Phone: 570-453-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003693
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: