Provider Demographics
NPI:1255529749
Name:SARDONIA, ANTHONY J (OD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:SARDONIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23861 MCBEAN PKWY
Mailing Address - Street 2:E-12
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2058
Mailing Address - Country:US
Mailing Address - Phone:661-259-6022
Mailing Address - Fax:661-259-9742
Practice Address - Street 1:23861 MCBEAN PKWY
Practice Address - Street 2:E-12
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2058
Practice Address - Country:US
Practice Address - Phone:661-259-6022
Practice Address - Fax:661-259-9742
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6341T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6341TOtherPROFESSIONAL LICENSE #