Provider Demographics
NPI:1417131186
Name:SANANIKONE, LOU (OD)
Entity Type:Individual
Prefix:DR
First Name:LOU
Middle Name:
Last Name:SANANIKONE
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 1:595 S GALLERIA WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4932
Mailing Address - Country:US
Mailing Address - Phone:480-375-2054
Mailing Address - Fax:
Practice Address - Street 1:595 S GALLERIA WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-4932
Practice Address - Country:US
Practice Address - Phone:480-375-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12489152W00000X
AZ1419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist