Provider Demographics
NPI:1093022584
Name:MONDAL, SANBRITA (OD)
Entity Type:Individual
Prefix:DR
First Name:SANBRITA
Middle Name:
Last Name:MONDAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2349 DEMING WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5530
Practice Address - Country:US
Practice Address - Phone:608-824-3937
Practice Address - Fax:608-833-3326
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3256-35152W00000X
MDTA2229152W00000X
MA4815152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist