Provider Demographics
NPI:1841059755
Name:SANDFORD, JOANNE B (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:B
Last Name:SANDFORD
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CUNNINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4260
Mailing Address - Country:US
Mailing Address - Phone:757-825-1181
Mailing Address - Fax:757-838-4925
Practice Address - Street 1:1900 CUNNINGHAM DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4260
Practice Address - Country:US
Practice Address - Phone:757-825-1181
Practice Address - Fax:757-838-4925
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101002110156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician