Provider Demographics
NPI:1467563676
Name:NARDIS, B. DEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:B.
Middle Name:DEAN
Last Name:NARDIS
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 1:344 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17004-8930
Mailing Address - Country:US
Mailing Address - Phone:717-329-6588
Mailing Address - Fax:
Practice Address - Street 1:4461 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17004-9266
Practice Address - Country:US
Practice Address - Phone:717-329-6588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA37415OtherAVESIS
PA49451OtherDAVIS VISION
PA24830OtherSTARMOUNT
PA0892436Medicaid
PA710862119OtherNVA
PA09389OtherSPECTERA
PA22802OtherBLUE SHIELD
PA42379OtherDAVIS VISION
PA919526OtherBLOCK VISION
PA37444OtherAVESIS
PA09389OtherSPECTERA