Provider Demographics
NPI:1497710032
Name:FERNANDO, RANGA (OD)
Entity Type:Individual
Prefix:DR
First Name:RANGA
Middle Name:
Last Name:FERNANDO
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 1:8460 LIMEKILN PIKE
Mailing Address - Street 2:BUILDING 1 - APARTMENT 528
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095
Mailing Address - Country:US
Mailing Address - Phone:215-784-0160
Mailing Address - Fax:
Practice Address - Street 1:2500 W MORELAND RD
Practice Address - Street 2:SUITE 3116
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-4003
Practice Address - Country:US
Practice Address - Phone:215-784-0160
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1808042OtherHIGH MARK BLUE SHIELD
PA7978616OtherAETNA
PAV03283Medicare UPIN
PA7978616OtherAETNA