Provider Demographics
NPI:1407952781
Name:CHANDER, SANDIP STEVEN (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDIP
Middle Name:STEVEN
Last Name:CHANDER
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 1:5460 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-3033
Mailing Address - Country:US
Mailing Address - Phone:773-735-6090
Mailing Address - Fax:773-581-0320
Practice Address - Street 1:5460 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-3033
Practice Address - Country:US
Practice Address - Phone:773-735-6090
Practice Address - Fax:773-581-0320
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00468891152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU65484Medicare UPIN
IL1291390001Medicare NSC