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General NPI Number Information
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NPI Number | 1205863693
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Entity Type | Individual
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Provider Name | SANDRA K DOLPHIN O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 213 S ADAMS ST
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City | ST CROIX FALLS
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State | WI
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Zip | 54024
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Country | US
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Telephone | 715-483-3259
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Fax | 715-483-5136
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Provider Business Mailing Address
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Address Line | 213 SOUTH ADAMS STREET
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City | ST CROIX FALLS
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State | WI
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Zip | 54024
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Country | US
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Telephone | 715-483-3259
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Fax | 715-483-5136
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2589-035
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License Number State | WI
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