Basic Information
| Provider Information | |||||||||
| NPI: | 1083086219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | SONAL | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 E GERMANN RD APT 2094 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852861773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3215145833 | ||||||||
| FaxNumber: | 4803589739 | ||||||||
| Practice Location | |||||||||
| Address1: | 1606 S SIGNAL BUTTE RD | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803589737 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2015 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2092 | AZ | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.