Provider Demographics
NPI:1265446462
Name:BRUNO, SARAH M (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:BRUNO
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 1:1230 SMITHBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9137
Mailing Address - Country:US
Mailing Address - Phone:215-970-6387
Mailing Address - Fax:
Practice Address - Street 1:1111 SMITHBRIDGE RD STE 1
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1207
Practice Address - Country:US
Practice Address - Phone:610-459-2020
Practice Address - Fax:610-558-7831
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG001785OtherPA STATE LICENSE NUMBER
PA1916994OtherPENNSYLVANIA BLUE SHIELD
V10506Medicare UPIN
PAOEG001785OtherPA STATE LICENSE NUMBER