Provider Demographics
NPI:1922403849
Name:CHRISTIE CARDELLINO, OD LLC
Entity Type:Organization
Organization Name:CHRISTIE CARDELLINO, OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDELLINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-242-3334
Mailing Address - Street 1:2441 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1440
Mailing Address - Country:US
Mailing Address - Phone:814-242-3334
Mailing Address - Fax:
Practice Address - Street 1:2441 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1440
Practice Address - Country:US
Practice Address - Phone:814-242-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026684310009Medicaid