Healthcare Provider Details

I. General information

NPI: 1871867416
Provider Name (Legal Business Name): DEENA SANDALL, OD., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 N ROCK RD
WICHITA KS
67206-1262
US

IV. Provider business mailing address

1141 N 199TH CIR W
GODDARD KS
67052-8835
US

V. Phone/Fax

Practice location:
  • Phone: 316-268-5000
  • Fax:
Mailing address:
  • Phone: 316-210-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1723
License Number StateKS

VIII. Authorized Official

Name: DEENA SANDALL
Title or Position: MEMBER
Credential: OD
Phone: 316-210-0362