Provider Demographics
NPI:1528415734
Name:FRITZ, SANDRA JANE (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JANE
Last Name:FRITZ
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:PENRYN
Mailing Address - State:CA
Mailing Address - Zip Code:95663-0349
Mailing Address - Country:US
Mailing Address - Phone:916-489-1110
Mailing Address - Fax:
Practice Address - Street 1:3755 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-9226
Practice Address - Country:US
Practice Address - Phone:916-489-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA067295156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA067295OtherAMERICAN BOARD OF OPTOMETRY