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General NPI Number Information
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NPI Number | 1396000840
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Entity Type | Individual
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Provider Name | WILFREDO SANDOVAL OD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 4813 SW 8TH ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-2522
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Country | US
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Telephone | 786-431-1635
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 ATLANTIC AVE
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City | OPA LOCKA
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State | FL
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Zip | 33054-3954
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Country | US
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Telephone | 956-286-7680
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Fax |
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 8109TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPC5086
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License Number State | FL
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