Provider Demographics
NPI:1548776370
Name:SION, SANDRA L (LDO)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:SION
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 1:5360 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3596
Mailing Address - Country:US
Mailing Address - Phone:716-646-0564
Mailing Address - Fax:716-646-0571
Practice Address - Street 1:5360 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3596
Practice Address - Country:US
Practice Address - Phone:716-646-0564
Practice Address - Fax:716-646-0571
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC-007909-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician