Provider Demographics
NPI:1346564705
Name:SEDLACEK, SANDRA (LDO)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SEDLACEK
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27380 COOK RD APT 79
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1098
Mailing Address - Country:US
Mailing Address - Phone:440-238-9020
Mailing Address - Fax:440-238-9121
Practice Address - Street 1:17100 ROYALTON RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-4441
Practice Address - Country:US
Practice Address - Phone:440-238-9020
Practice Address - Fax:440-238-9121
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.7413156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician