Provider Demographics
NPI:1952907867
Name:SONI, SONAL
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:
Last Name:SONI
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 1:3412 FLAGLER AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4608
Mailing Address - Country:US
Mailing Address - Phone:305-304-4451
Mailing Address - Fax:
Practice Address - Street 1:10991 SAN JOSE BLVD STE 32
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6635
Practice Address - Country:US
Practice Address - Phone:904-292-0947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5888152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist