Provider Demographics
NPI:1982711446
Name:CHENG, SANDRA (OD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CHENG
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 1:101 SOUTH SAN MATEO DRIVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3844
Mailing Address - Country:US
Mailing Address - Phone:650-342-7474
Mailing Address - Fax:650-342-9260
Practice Address - Street 1:101 SOUTH SAN MATEO DRIVE
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3844
Practice Address - Country:US
Practice Address - Phone:650-342-7474
Practice Address - Fax:650-342-9260
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11502T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U90453Medicare UPIN
CASD0115020Medicare PIN