Provider Demographics
NPI:1659821940
Name:SANDLER, MICHELLE JESSICA (OD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JESSICA
Last Name:SANDLER
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 1:22 PATRIOT PL FL 3
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1375
Mailing Address - Country:US
Mailing Address - Phone:866-378-9164
Mailing Address - Fax:
Practice Address - Street 1:22 PATRIOT PL FL 3
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-1375
Practice Address - Country:US
Practice Address - Phone:866-378-9164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist