Provider Demographics
NPI:1104999523
Name:SANTIZO, WENDY (OD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:SANTIZO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 CHELTENHAM RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-2232
Mailing Address - Country:US
Mailing Address - Phone:805-682-8438
Mailing Address - Fax:
Practice Address - Street 1:1629 STATE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2548
Practice Address - Country:US
Practice Address - Phone:805-569-2318
Practice Address - Fax:805-569-0230
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8319T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT 8319OtherOPTOMETRY LICENSE
CA418-8912-2OtherEDD
CAOPT 8319OtherOPTOMETRY LICENSE
CAU60103Medicare UPIN