MEDICARE: DR. SANDRA L FARNHAM O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1997	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	093VN	OTHER	NC	BCBSNC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538139597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA L FARNHAM O.D.

Provider Business Mailing Address
First Line	:	640 SUMMIT CROSSING PL
Second Line	:	SUITE 202
City	:	GASTONIA
State	:	NC
Zip	:	28054-2142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	640 SUMMIT CROSSING PL
Second Line	:	SUITE 202
City	:	GASTONIA
State	:	NC
Zip	:	28054-2142
Country	:	US
Telephone Number	:	704-865-3937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	12/11/2007

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