Provider Demographics
NPI:1336871870
Name:LUGO, SANDIBEL SARELY
Entity Type:Individual
Prefix:
First Name:SANDIBEL
Middle Name:SARELY
Last Name:LUGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 HWY 9 BYPASS W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720
Mailing Address - Country:US
Mailing Address - Phone:803-286-4826
Mailing Address - Fax:803-286-5938
Practice Address - Street 1:805 HIGHWAY 9 BYPASS W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720
Practice Address - Country:US
Practice Address - Phone:803-286-4826
Practice Address - Fax:803-286-5938
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC578156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician