Provider Demographics
NPI:1952954695
Name:SANDRIK, JERIANN (OD)
Entity type:Individual
Prefix:DR
First Name:JERIANN
Middle Name:
Last Name:SANDRIK
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:CMR 405 BOX 3359
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09034-0134
Mailing Address - Country:US
Mailing Address - Phone:314-590-1126
Mailing Address - Fax:
Practice Address - Street 1:UNIT 23809 BOX BAUMHOLDER
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09034-3809
Practice Address - Country:US
Practice Address - Phone:314-590-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5676152W00000X
SC2163152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist