=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922045384
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEVIN M SARNO O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 01/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10785 102ND AVE
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33778-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-209-3937
-----------------------------------------------------
Fax | 727-394-7393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11650 131ST ST
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33774-4740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-489-0500
-----------------------------------------------------
Fax | 727-489-0508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC002894
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------