Provider Demographics
NPI:1417203944
Name:TRAVAGLIANTI, SANDRA K (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:K
Last Name:TRAVAGLIANTI
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 1:8200 JOYCE RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-1433
Mailing Address - Country:US
Mailing Address - Phone:440-785-7492
Mailing Address - Fax:
Practice Address - Street 1:8934 DARROW RD
Practice Address - Street 2:SPACE C104
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2129
Practice Address - Country:US
Practice Address - Phone:330-425-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6164152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist