Provider Demographics
NPI:1356911606
Name:KANDOLA, SUKHJINDER (OD)
Entity type:Individual
Prefix:
First Name:SUKHJINDER
Middle Name:
Last Name:KANDOLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21639 BRONTE PL
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4783
Mailing Address - Country:US
Mailing Address - Phone:571-291-1923
Mailing Address - Fax:
Practice Address - Street 1:3553 16TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3041
Practice Address - Country:US
Practice Address - Phone:571-291-1923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist