Healthcare Provider Details

I. General information

NPI: 1063345155
Provider Name (Legal Business Name): SANDRA MEENA NANDOO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 W DEVON DR STE 101
EXTON PA
19341-3008
US

IV. Provider business mailing address

111 E 4TH ST STE 440
ALTON IL
62002-6206
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-8960
  • Fax:
Mailing address:
  • Phone: 618-462-9818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004365
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: