Provider Demographics
NPI:1144377888
Name:TRULL, SANDRA DI'ANN (OD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DI'ANN
Last Name:TRULL
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 1:10695 CORNERSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4205
Mailing Address - Country:US
Mailing Address - Phone:209-951-8888
Mailing Address - Fax:
Practice Address - Street 1:5308 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5619
Practice Address - Country:US
Practice Address - Phone:209-952-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10889152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist