Provider Demographics
NPI:1669458055
Name:NARDIS, DONALD BUTLER (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:BUTLER
Last Name:NARDIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:802 EAST SIMPSON ST
Mailing Address - Street 2:EYECARE PLUS
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-3461
Mailing Address - Country:US
Mailing Address - Phone:717-766-1507
Mailing Address - Fax:717-591-1988
Practice Address - Street 1:802 E SIMPSON ST
Practice Address - Street 2:EYECARE PLUS
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-3461
Practice Address - Country:US
Practice Address - Phone:717-766-1507
Practice Address - Fax:717-591-1988
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOE5276P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA37521Medicare ID - Type Unspecified
0796920001Medicare NSC
T27264Medicare UPIN