Provider Demographics
NPI:1982757407
Name:SANDERS,GARRELS, KESWANI PARTNERSHIP
Entity type:Organization
Organization Name:SANDERS,GARRELS, KESWANI PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-234-1730
Mailing Address - Street 1:11780 SAN PABLO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-7103
Mailing Address - Country:US
Mailing Address - Phone:510-234-1730
Mailing Address - Fax:510-234-8841
Practice Address - Street 1:11780 SAN PABLO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-7103
Practice Address - Country:US
Practice Address - Phone:510-234-1730
Practice Address - Fax:510-234-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 2141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000930Medicaid
ZZZ00003ZMedicare PIN
ZZZ00003ZMedicare PIN