Provider Demographics
NPI:1043352503
Name:CARDILLO, DENNIS ARMAND SR (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ARMAND
Last Name:CARDILLO
Suffix:SR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 STATION AVENUE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1636
Mailing Address - Country:US
Mailing Address - Phone:856-546-8686
Mailing Address - Fax:856-546-0959
Practice Address - Street 1:714 STATION AVENUE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1636
Practice Address - Country:US
Practice Address - Phone:856-546-8686
Practice Address - Fax:856-546-0959
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00404700152W00000X
NJ27TO00105100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1529706Medicaid
NJCA423951Medicare ID - Type Unspecified
U26651Medicare UPIN