Provider Demographics
NPI:1902258742
Name:HUENINK, SANDRA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARIE
Last Name:HUENINK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3278 MAIN ST
Mailing Address - Street 2:PO BOX 165
Mailing Address - City:EAST TROY
Mailing Address - State:WI
Mailing Address - Zip Code:53120-1152
Mailing Address - Country:US
Mailing Address - Phone:262-642-9719
Mailing Address - Fax:262-642-2228
Practice Address - Street 1:3278 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST TROY
Practice Address - State:WI
Practice Address - Zip Code:53120-1152
Practice Address - Country:US
Practice Address - Phone:262-642-9719
Practice Address - Fax:262-642-2228
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3415-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist