Provider Demographics
NPI:1235282377
Name:DAOUD, SANDRA VICTOR (OD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:VICTOR
Last Name:DAOUD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:VICTOR
Other - Last Name:ZAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:95 WASHINGTON ST
Mailing Address - Street 2:STE 466
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-4008
Mailing Address - Country:US
Mailing Address - Phone:781-821-1224
Mailing Address - Fax:877-992-0275
Practice Address - Street 1:95 WASHINGTON ST
Practice Address - Street 2:STE 466
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4008
Practice Address - Country:US
Practice Address - Phone:781-821-1224
Practice Address - Fax:877-992-0275
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4299152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0338800Medicaid
MAU9474Medicare UPIN
MAW17467Medicare ID - Type Unspecified