Provider Demographics
NPI:1255498416
Name:BWINT, SANDRA (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:BWINT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CHEYNEY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1022
Mailing Address - Country:US
Mailing Address - Phone:610-558-4416
Mailing Address - Fax:
Practice Address - Street 1:1367 DILWORTHTOWN XING
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-8266
Practice Address - Country:US
Practice Address - Phone:610-399-3700
Practice Address - Fax:610-399-9753
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE006708P152W00000X
NJ27OA0047900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU09399Medicare UPIN
NJ640068Medicare ID - Type UnspecifiedSAME ID WAS GIVEN FOR PA