Provider Demographics
NPI:1033377593
Name:SAMUEL SCARDINOO.D.,P.A.
Entity Type:Organization
Organization Name:SAMUEL SCARDINOO.D.,P.A.
Other - Org Name:ADVANCED OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-296-2020
Mailing Address - Street 1:2830 N HIAWASSEE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3319
Mailing Address - Country:US
Mailing Address - Phone:407-296-2020
Mailing Address - Fax:407-294-0074
Practice Address - Street 1:2830 N HIAWASSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3319
Practice Address - Country:US
Practice Address - Phone:407-296-2020
Practice Address - Fax:407-294-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078826100Medicaid
FL19195Medicare PIN
FLT84250Medicare UPIN
FL0653490001Medicare NSC