Provider Demographics
NPI:1295179034
Name:SARDINHA, DAVID (RO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SARDINHA
Suffix:
Gender:M
Credentials:RO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 METACOM AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-5179
Mailing Address - Country:US
Mailing Address - Phone:401-253-5688
Mailing Address - Fax:401-253-3220
Practice Address - Street 1:375 METACOM AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-5179
Practice Address - Country:US
Practice Address - Phone:401-253-5688
Practice Address - Fax:401-253-3220
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOP128156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician