Healthcare Provider Details

I. General information

NPI: 1376760157
Provider Name (Legal Business Name): RICHARD SANDS L.D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4128 CALIFORNIA AVE SW
SEATTLE WA
98116-4102
US

IV. Provider business mailing address

PO BOX 621
TRACYTON WA
98393-0621
US

V. Phone/Fax

Practice location:
  • Phone: 206-935-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO 2079
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: