Provider Demographics
NPI:1992833214
Name:SPARROW, POLLYANNA ROBERTA (OD)
Entity Type:Individual
Prefix:DR
First Name:POLLYANNA
Middle Name:ROBERTA
Last Name:SPARROW
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 1:34 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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007080T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003265Medicare ID - Type Unspecified
PAT87958Medicare UPIN