Provider Demographics
NPI:1083920219
Name:SANDHU, MANEEK KAUR (OD)
Entity Type:Individual
Prefix:
First Name:MANEEK
Middle Name:KAUR
Last Name:SANDHU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MANEEK
Other - Middle Name:
Other - Last Name:KAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:611 HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3075
Mailing Address - Country:US
Mailing Address - Phone:734-983-0028
Mailing Address - Fax:
Practice Address - Street 1:654 BRIARWOOD CIR
Practice Address - Street 2:BRIARWOOD MALL STE #D128
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1612
Practice Address - Country:US
Practice Address - Phone:734-761-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN26930201Medicare PIN