Provider Demographics
NPI:1659543015
Name:POLLYANNA SPARROW OD PC
Entity Type:Organization
Organization Name:POLLYANNA SPARROW OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:POLLYANNA
Authorized Official - Middle Name:ROBERTA
Authorized Official - Last Name:SPARROW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-759-6515
Mailing Address - Street 1:34 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2036
Mailing Address - Country:US
Mailing Address - Phone:610-759-6515
Mailing Address - Fax:
Practice Address - Street 1:34 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2036
Practice Address - Country:US
Practice Address - Phone:610-759-6515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007080T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT87958Medicare UPIN
PA0394530001Medicare NSC
PA003265Medicare PIN