Provider Demographics
NPI:1346414000
Name:THORNTON, SANDRA ROSE (COT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ROSE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:COT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000-2 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4024
Mailing Address - Country:US
Mailing Address - Phone:904-384-3500
Mailing Address - Fax:904-388-9132
Practice Address - Street 1:3 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 134
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4757
Practice Address - Country:US
Practice Address - Phone:904-384-3500
Practice Address - Fax:904-388-9132
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist