Sandra Phan, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046010174 Issued in IL

Practice address

8407 Roosevelt Ave
Jackson Heights, NY 11372-7340

Phone

(718) 651-2020

Fax

(718) 651-2034

NPI assigned

Oct 24, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/7032/brand/1/csg/1/fhir/r4

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

• Phanod LLC

  • Health Service Clinic/Center
  • Jackson Heights, NY
  • NPI 1700486800
  Medicare reassignment Authorized official
• Epic Medical Group,Inc

  • Critical Care Medicine (Internal Medicine) Physician
  • Sherman Oaks, CA
  • NPI 1295178689
  NPD (past)

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

{
    "created_epoch": "1224806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1760635510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8407 ROOSEVELT AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727340",
            "telephone_number": "718-651-2020",
            "fax_number": "718-651-2034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8407 ROOSEVELT AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727340",
            "telephone_number": "718-651-2020",
            "fax_number": "718-651-2034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "SANDRA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-24",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard St Michael Perrin, M.D.
• Paris Ernst Petersen, DDS
• Michael Anthony Petruzillo, DDS
• PG Rides Inc
• Huong Thi Phan, MHC
• Phanod LLC
• Adrianna Ellice Philippe
• Whitney Winnifred Phillips, PA-C
• Magalie Pierre-Louis, M.D.
• Joanne Pierre, NP

• Optometrist in Jackson Heights, NY
• Providers in Jackson Heights, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.