MEDICARE: SANDRA L EASTER OD

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	KS1547	KS
2	332H00000X	Eyewear Supplier
3	152W00000X	Optometrist	5699	TX

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	:	1871686055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA L EASTER OD

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	972-279-2020
Fax Number	:	972-279-2637

Provider Business Practice Location Address
First Line	:	610 N TWNEAST BLVD STE 100
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-4705
Country	:	US
Telephone Number	:	972-279-2020
Fax Number	:	972-279-2637

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	11/30/2023

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Directions to “ SANDRA L EASTER OD” Practice Location

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