Provider Demographics
NPI:1679539480
Name:SCARDINO, SAMUEL (OD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:SCARDINO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:
Other - Last Name:SCARDINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD PA
Mailing Address - Street 1:2830 N HIAWASSEE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3319
Mailing Address - Country:US
Mailing Address - Phone:407-296-2020
Mailing Address - Fax:407-294-0074
Practice Address - Street 1:2830 N HIAWASSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3319
Practice Address - Country:US
Practice Address - Phone:407-296-2020
Practice Address - Fax:407-294-0074
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078826100Medicaid
FLT84250Medicare UPIN
FL19195Medicare PIN
FL0653490001Medicare NSC