Basic Information
| Provider Information | |||||||||
| NPI: | 1922045384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SARNO | ||||||||
| FirstName: | NEVIN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11650 131ST ST | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337744740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274890500 | ||||||||
| FaxNumber: | 7274890508 | ||||||||
| Practice Location | |||||||||
| Address1: | 10785 102ND AVE | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337784211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272093937 | ||||||||
| FaxNumber: | 7273947393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 01/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC002894 | FL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 620254300 | 05 | FL | MEDICAID |