Kenneth J Sandker, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3308 Issued in OH

Practice address

1025 Grand Lake Rd
Celina, OH 45822-1309

Phone

(419) 586-3151

Fax

(419) 586-1059

NPI assigned

Feb 23, 2007

Last updated

Dec 3, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grand Lake Eyecare LLC

  • Optometrist
  • Celina, OH
  • NPI 1548301690
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386028800000",
    "number": "1023143419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 377",
            "city": "CELINA",
            "state": "OH",
            "postal_code": "458220377",
            "telephone_number": "419-586-3151",
            "fax_number": "419-586-1059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 GRAND LAKE RD",
            "city": "CELINA",
            "state": "OH",
            "postal_code": "458221309",
            "telephone_number": "419-586-3151",
            "fax_number": "419-586-1059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDKER",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-23",
        "last_updated": "2013-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLE MANAGED VISION",
            "identifier": "141478",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "71115",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000367947",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Sue Rosenbeck-Rose, LPCC-S
• Brandon Ross
• Claire Elizabeth Rutledge
• Traci Lynn Rutledge, RPH
• Michelle Salazar, LISW-S
• Laura B Sanford, LSW
• Shanthi Nmi Satyanarayana, MD
• James Edmund Sauer, D.C
• Jennifer L Schaefer
• Thomas Allen Schatzer, LICDC

• Optometrist in Celina, OH
• Providers in Celina, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.