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General NPI Number Information
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NPI Number | 1417203944
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Entity Type | Individual
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Provider Name | SANDRA K TRAVAGLIANTI O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 8934 DARROW RD SPACE C104
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City | TWINSBURG
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State | OH
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Zip | 44087-2129
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Country | US
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Telephone | 330-425-9830
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 JOYCE RD
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-1433
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Country | US
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Telephone | 440-785-7492
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Fax |
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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 | 6164
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License Number State | OH
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