Provider Demographics
NPI:1578516977
Name:OU, SANDIA JEN (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDIA
Middle Name:JEN
Last Name:OU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25 E HUNTINGTON DR
Mailing Address - Street 2:SUITE #111
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3210
Mailing Address - Country:US
Mailing Address - Phone:626-393-8885
Mailing Address - Fax:
Practice Address - Street 1:25 E HUNTINGTON DR
Practice Address - Street 2:SUITE #111
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3210
Practice Address - Country:US
Practice Address - Phone:626-393-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12911 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0129110Medicaid
CAV10286Medicare UPIN