MEDICARE: DR. L VICTOR SANDOVAL O.D.

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	260	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841274313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. L VICTOR SANDOVAL O.D.

Provider Business Mailing Address
First Line	:	700 S TELSHOR BLVD
Second Line	:	STE 1534
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4669
Country	:	US
Telephone Number	:	575-522-8334
Fax Number	:	575-522-1065

Provider Business Practice Location Address
First Line	:	700 S TELSHOR BLVD
Second Line	:	STE 1534
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4669
Country	:	US
Telephone Number	:	575-522-8334
Fax Number	:	575-522-1065

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	10/06/2011

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