Provider Demographics
NPI:1710289673
Name:SARAH BRUNO O.D.P.C.
Entity Type:Organization
Organization Name:SARAH BRUNO O.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:610-459-2020
Mailing Address - Street 1:4 THISTLE LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5627
Mailing Address - Country:US
Mailing Address - Phone:215-840-9705
Mailing Address - Fax:610-558-7831
Practice Address - Street 1:98 WILMINGTON W CHESTER PIKE
Practice Address - Street 2:SUITE102
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9010
Practice Address - Country:US
Practice Address - Phone:610-459-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAYDK6OtherMEDICARE GROUP SUFFIX
PA3816083000OtherPERSONAL CHOICE / KEYSTONE HEALTH PLAN
PAYDK6OtherMEDICARE GROUP SUFFIX
PAYDK6OtherMEDICARE GROUP SUFFIX