Provider Demographics
NPI:1326155318
Name:FOX, SANDRA (OD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:FOX
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:UTHSCSA, UTHSCSA, DEPT. OF OPHTHALMOLOGY
Mailing Address - Street 2:7703 FLOYD CURL DRIVE, RM 4.516MCD
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-567-8600
Mailing Address - Fax:
Practice Address - Street 1:8403 FLOYD CURL DR RM 1.110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3904
Practice Address - Country:US
Practice Address - Phone:210-257-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03646TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112427304OtherCIDC
TX112427301Medicaid
TX112427304OtherCIDC
TX84942JMedicare PIN
TX8L12000Medicare PIN