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General NPI Number Information
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NPI Number | 1508903535
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Entity Type | Individual
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Provider Name | SUE ANN SANFORD O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 2301 PORTER CREEK DR STE 217
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City | FORT WORTH
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State | TX
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Zip | 76177-2336
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Country | US
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Telephone | 817-847-7747
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Fax | 817-847-7783
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Provider Business Mailing Address
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Address Line | 2301 PORTER CREEK DR STE 217
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City | FORT WORTH
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State | TX
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Zip | 76177-2336
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Country | US
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Telephone | 817-847-7747
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Fax | 817-847-7783
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004414
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 4240
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6766T
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License Number State | TX
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