Provider Demographics
NPI:1881932341
Name:SARDELLA EYE ASSOCIATES, LLC
Entity type:Organization
Organization Name:SARDELLA EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BORBIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-558-3937
Mailing Address - Street 1:1810 WILMINGTON PIKE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-8177
Mailing Address - Country:US
Mailing Address - Phone:610-558-3937
Mailing Address - Fax:610-558-4154
Practice Address - Street 1:1810 WILMINGTON PIKE
Practice Address - Street 2:SUITE 13
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-8177
Practice Address - Country:US
Practice Address - Phone:610-558-3937
Practice Address - Fax:610-558-4154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOB008953305R00000X
PAOEG000297305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization