Provider Demographics
NPI:1063475572
Name:SARDELLA, RENNY S (OD)
Entity Type:Individual
Prefix:
First Name:RENNY
Middle Name:S
Last Name:SARDELLA
Suffix:
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 1:1810 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2408
Mailing Address - Country:US
Mailing Address - Phone:610-466-9909
Mailing Address - Fax:610-383-6256
Practice Address - Street 1:1810 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2408
Practice Address - Country:US
Practice Address - Phone:610-466-9909
Practice Address - Fax:610-383-6256
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOB007679A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA580133Medicare PIN
PAU55899Medicare UPIN