MEDICARE: GHEENA SANTHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	721344	CO

General Provider Information

NPI Number	:	1588595268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHEENA SANTHA

Provider Business Mailing Address
First Line	:	1930 DAPPLEGREY LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-4592
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4430 N NEVADA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4310
Country	:	US
Telephone Number	:	719-635-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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Directions to “ GHEENA SANTHA ” Practice Location

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