Provider Demographics
NPI:1639263668
Name:ELSTON, SANDRA (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:ELSTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 E SANDY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3090
Mailing Address - Country:US
Mailing Address - Phone:972-393-3937
Mailing Address - Fax:972-304-4422
Practice Address - Street 1:541 E SANDY LAKE RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3090
Practice Address - Country:US
Practice Address - Phone:972-393-3937
Practice Address - Fax:972-304-4422
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5851TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821379991OtherGROUP NPI
TX81443QOtherBLUECROSS BLUE SHIELD
TX613961OtherMEDICARE GROUP PTAN
TX1821379991OtherGROUP NPI
TX613961OtherMEDICARE GROUP PTAN