Provider Demographics
NPI:1639195373
Name:CONSIGLIO, CINDY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:LYNN
Last Name:CONSIGLIO
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 1:1952 HUNT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5726
Mailing Address - Country:US
Mailing Address - Phone:610-410-5146
Mailing Address - Fax:
Practice Address - Street 1:567 ROUTE 100 N
Practice Address - Street 2:
Practice Address - City:BECHTELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19505-9263
Practice Address - Country:US
Practice Address - Phone:610-367-1076
Practice Address - Fax:610-367-1081
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA555239OtherNVA PROVIDER PIN
PA555239OtherNVA PROVIDER PIN
PA098296Medicare ID - Type Unspecified