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General NPI Number Information
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NPI Number | 1164523924
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Entity Type | Individual
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Provider Name | SARAH BETH NISSEN O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 2805 W CHESTER PIKE
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City | BROOMALL
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State | PA
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Zip | 19008-1827
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Country | US
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Telephone | 610-356-3933
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Fax | 610-356-3324
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Provider Business Mailing Address
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Address Line | 243 HAVERFORD RD
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3318
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Country | US
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Telephone | 610-930-6858
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Fax | 610-356-3324
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG001885
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License Number State | PA
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