Provider Demographics
NPI:1932926045
Name:UPCRAFT, SANDRA L (OPHTHALMIC DISPENSER)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:UPCRAFT
Suffix:
Gender:F
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1818 STATE ROUTE 3 STE A
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1567
Mailing Address - Country:US
Mailing Address - Phone:315-598-1668
Mailing Address - Fax:315-598-1671
Practice Address - Street 1:1818 STATE ROUTE 3 STE A
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1567
Practice Address - Country:US
Practice Address - Phone:315-598-1668
Practice Address - Fax:315-598-1671
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008232-01156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician