Provider Demographics
NPI:1336159268
Name:SCOMBORDI-RAGHU, BRANDY (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:
Last Name:SCOMBORDI-RAGHU
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 OSWIN TURN
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2054
Mailing Address - Country:US
Mailing Address - Phone:215-572-0210
Mailing Address - Fax:215-276-1329
Practice Address - Street 1:1200 W GODFREY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3323
Practice Address - Country:US
Practice Address - Phone:215-276-6000
Practice Address - Fax:215-276-1329
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000420152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2248OtherAETNA HMO
PA2299722000OtherKEYSTONE EAST
PA1622822OtherBLUE SHIELD
PAU74080Medicare UPIN
PA024491Medicare ID - Type Unspecified