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General NPI Number Information
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NPI Number | 1801084249
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Entity Type | Organization
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Legal Business Name | SUE ANN SANFORD, O.D.,P.A.
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 1580 MIRA LAGO BLVD APT 169
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City | DALLAS
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State | TX
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Zip | 75234-6079
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Country | US
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Telephone | 630-886-4115
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 MIRA LAGO BLVD APT 169
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City | DALLAS
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State | TX
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Zip | 75234-6079
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Country | US
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Telephone | 630-886-4115
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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Name | DR. SUE ANN SANFORD
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Credential | O.D.
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Telephone | 630-886-4115
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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 | OPC 4240
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License Number State | FL
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