Provider Demographics
NPI:1588959043
Name:BANK, SANDRA (OPTICIAN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BANK
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4131
Mailing Address - Country:US
Mailing Address - Phone:414-484-8700
Mailing Address - Fax:
Practice Address - Street 1:1100 REISTERSTOWN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4131
Practice Address - Country:US
Practice Address - Phone:414-484-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician