Provider Demographics
NPI:1871661678
Name:RAO, SANDHYA (OD)
Entity Type:Individual
Prefix:
First Name:SANDHYA
Middle Name:
Last Name:RAO
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 1:11103 WEST AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1370
Mailing Address - Country:US
Mailing Address - Phone:726-444-4043
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:873 SAINT GEORGE AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2514
Practice Address - Country:US
Practice Address - Phone:732-750-3900
Practice Address - Fax:732-750-4869
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA557000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ017498CQTMedicare PIN
NJU72136Medicare UPIN