Organization
GRAND LAKE EYECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH J SANDKER OD (PARTNER)
(419) 586-3151
Entity
Organization
Contact information
Practice address
1025 GRAND LAKE RD, CELINA, OH 45822-1309
(419) 586-3151
(419) 586-1059
Mailing address
PO BOX 377, CELINA, OH 45822-0377
(419) 586-3151
(419) 586-1059
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
02/10/2007
Last updated
02/05/2008
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