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General NPI Number Information
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NPI Number | 1871867416
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Entity Type | Organization
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Legal Business Name | DEENA SANDALL, OD., LLC
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 1151 N ROCK RD
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City | WICHITA
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State | KS
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Zip | 67206-1262
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Country | US
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Telephone | 316-268-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1141 N 199TH CIR W
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City | GODDARD
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State | KS
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Zip | 67052-8835
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Country | US
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Telephone | 316-210-0362
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DEENA SANDALL
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Credential | OD
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Telephone | 316-210-0362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 1723
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License Number State | KS
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