Provider Demographics
NPI:1205863693
Name:DOLPHIN, SANDRA K (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:K
Last Name:DOLPHIN
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 1:213 SOUTH ADAMS STREET
Mailing Address - Street 2:
Mailing Address - City:ST CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024
Mailing Address - Country:US
Mailing Address - Phone:715-483-3259
Mailing Address - Fax:715-483-5136
Practice Address - Street 1:213 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:ST CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024
Practice Address - Country:US
Practice Address - Phone:715-483-3259
Practice Address - Fax:715-483-5136
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2589-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI22-02486OtherMEDICA/SELECT CARE
WIHP26431OtherHEALTH PARTNERS
WI97969-1007552OtherPREFERRED ONE
5173080001OtherDMEPOS
WIP00175525OtherRAILROAD MEDICARE
WI38623500Medicaid
MN538722180OtherMN MA
WI270L2DOOtherBCBS MN
WI511297OtherNVA
WI270L2DOOtherBCBS MN
WI511297OtherNVA
WI38623500Medicaid