Provider Demographics
NPI:1770580086
Name:JOSHLENE D SANDHU PLLC
Entity type:Organization
Organization Name:JOSHLENE D SANDHU PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHLENE
Authorized Official - Middle Name:DEEPKA
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-544-5801
Mailing Address - Street 1:1414 116TH AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3801
Mailing Address - Country:US
Mailing Address - Phone:425-502-7922
Mailing Address - Fax:425-502-7975
Practice Address - Street 1:1414 116TH AVE NE STE B
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3801
Practice Address - Country:US
Practice Address - Phone:425-502-7922
Practice Address - Fax:425-502-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602074929261QS0132X
WAOD00001765152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0149521OtherWA L&I GROUP NUMBER
WA2025047Medicaid
WA6478610001Medicare NSC
WA2025047Medicaid