Provider Demographics
NPI:1801960737
Name:DIPONIO, SANDY ANNA (OD)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:ANNA
Last Name:DIPONIO
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 1:33620 ARGONNE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1404
Mailing Address - Country:US
Mailing Address - Phone:248-427-0083
Mailing Address - Fax:
Practice Address - Street 1:2550 S TELEGRAPH RD STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0951
Practice Address - Country:US
Practice Address - Phone:248-258-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003814152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist