=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881117711
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEEVAN SANDHU OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2017
-----------------------------------------------------
Last Update Date | 01/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23207 N SCOTTSDALE RD STE B105
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-4487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-741-8181
-----------------------------------------------------
Fax | 480-741-8182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23207 N SCOTTSDALE RD STE B105
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-4487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-741-8181
-----------------------------------------------------
Fax | 480-741-8182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2200
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------