Provider Demographics
NPI:1659447928
Name:COLLAZO, SANDRA E (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:E
Last Name:COLLAZO
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 1:9514 RIVERLAND LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-4374
Mailing Address - Country:US
Mailing Address - Phone:713-827-9800
Mailing Address - Fax:713-827-9808
Practice Address - Street 1:10488 OLD KATY RD
Practice Address - Street 2:A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-5106
Practice Address - Country:US
Practice Address - Phone:713-827-9800
Practice Address - Fax:713-827-9808
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5109TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101690903Medicaid
TX760681065OtherTAX ID
TX760681065OtherTAX ID
TXU66459Medicare UPIN