Provider Demographics
NPI:1306369574
Name:NANCHERLA, SANJAY (OD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:
Last Name:NANCHERLA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N LOOP 1604 E STE 1103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1399
Mailing Address - Country:US
Mailing Address - Phone:210-364-2226
Mailing Address - Fax:
Practice Address - Street 1:115 N LOOP 1604 E STE 1103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1399
Practice Address - Country:US
Practice Address - Phone:210-635-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9256TG152W00000X
OK2946152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty