Provider Demographics
NPI:1053413633
Name:CARDILLO, CARRIE ALLGEIER (OD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ALLGEIER
Last Name:CARDILLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:ALLGEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:703 RUTTER AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4801
Mailing Address - Country:US
Mailing Address - Phone:570-288-7405
Mailing Address - Fax:570-288-7406
Practice Address - Street 1:703 RUTTER AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-4801
Practice Address - Country:US
Practice Address - Phone:570-288-7405
Practice Address - Fax:570-288-7406
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000483152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001837706Medicaid
U84162Medicare UPIN
PA001837706Medicaid