Provider Demographics
NPI:1871867416
Name:DEENA SANDALL, OD
Entity Type:Organization
Organization Name:DEENA SANDALL, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-440-1600
Mailing Address - Street 1:610 N MAIN ST STE 213
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3619
Mailing Address - Country:US
Mailing Address - Phone:316-440-1600
Mailing Address - Fax:316-440-1695
Practice Address - Street 1:610 N MAIN ST STE 213
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3619
Practice Address - Country:US
Practice Address - Phone:316-440-1600
Practice Address - Fax:316-440-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1723152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty