Individual
SANDA WIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1725 S PUEBLO BLVD, PUEBLO, CO 81005-2103
(719) 281-2633
(719) 281-2634
Mailing address
2221 E BIJOU ST STE 100, COLORADO SPRINGS, CO 80909-8009
(719) 576-1850
(719) 955-3470
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT.0003418
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346664877
—
CO
01
—
OPT.0003418
CO OPTOMETRY LICENSE
CO
Enumeration date
02/04/2014
Last updated
06/12/2019
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