Provider Demographics
NPI:1427044809
Name:ROBEL-HALL, SANDRA J (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:J
Last Name:ROBEL-HALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:10529 HOSLER RD STE A
Mailing Address - Street 2:
Mailing Address - City:LEO
Mailing Address - State:IN
Mailing Address - Zip Code:46765-9736
Mailing Address - Country:US
Mailing Address - Phone:260-627-2669
Mailing Address - Fax:260-627-2011
Practice Address - Street 1:10240 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2035
Practice Address - Country:US
Practice Address - Phone:260-497-8626
Practice Address - Fax:260-627-2011
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003563A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU010906Medicare UPIN