Healthcare Provider Details

I. General information

NPI: 1487893848
Provider Name (Legal Business Name): SARDELLA EYE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 UNIONVILLE RD
KENNETT SQUARE PA
19348-4712
US

IV. Provider business mailing address

674 UNIONVILLE RD
KENNETT SQUARE PA
19348-4712
US

V. Phone/Fax

Practice location:
  • Phone: 610-444-1999
  • Fax: 610-444-3133
Mailing address:
  • Phone: 610-444-1999
  • Fax: 610-444-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOE007679A
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RENNY STEPHEN SARDELLA
Title or Position: OWNER
Credential: O.D.
Phone: 610-444-1999