Provider Demographics
NPI:1255802401
Name:RIVERA SANDOVAL, LUIS FRANCISCO (OD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FRANCISCO
Last Name:RIVERA 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 1:4373 CORUNNA RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4351
Mailing Address - Country:US
Mailing Address - Phone:810-230-1444
Mailing Address - Fax:
Practice Address - Street 1:4373 CORUNNA RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4152
Practice Address - Country:US
Practice Address - Phone:810-230-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR741-0438152W00000X
WI3541-35152W00000X
MI4901005184152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist