Provider Demographics
NPI:1245528207
Name:SANDOVAL, ESTEBAN (OD)
Entity type:Individual
Prefix:DR
First Name:ESTEBAN
Middle Name:
Last Name:SANDOVAL
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 1:5990 DAHLIA ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-3708
Mailing Address - Country:US
Mailing Address - Phone:303-287-3937
Mailing Address - Fax:720-729-8262
Practice Address - Street 1:1601 E 19TH AVE STE 4525
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1290
Practice Address - Country:US
Practice Address - Phone:303-861-2020
Practice Address - Fax:720-729-8262
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007733152W00000X
CO3024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400055523Medicare PIN