Provider Demographics
NPI:1922057439
Name:VAN SANDT, DONALD JOE (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOE
Last Name:VAN SANDT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11976 HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-5328
Mailing Address - Country:US
Mailing Address - Phone:903-668-1965
Mailing Address - Fax:
Practice Address - Street 1:2440 GILMER RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2134
Practice Address - Country:US
Practice Address - Phone:903-261-2637
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2765T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist