Provider Demographics
NPI:1164926630
Name:EMILY SANDOC OD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:EMILY SANDOC OD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANDOC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-295-2900
Mailing Address - Street 1:5638 MISSION CENTER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4348
Mailing Address - Country:US
Mailing Address - Phone:619-295-2900
Mailing Address - Fax:
Practice Address - Street 1:5638 MISSION CENTER RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4348
Practice Address - Country:US
Practice Address - Phone:619-295-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty