Provider Demographics
NPI:1093779514
Name:CARMAN, SANDRA KAY (OD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:CARMAN
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 1:104 N FREEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:MN
Mailing Address - Zip Code:56156-1628
Mailing Address - Country:US
Mailing Address - Phone:507-283-2345
Mailing Address - Fax:507-283-2346
Practice Address - Street 1:104 N FREEMAN AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156-1628
Practice Address - Country:US
Practice Address - Phone:507-283-2345
Practice Address - Fax:507-283-2346
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD606152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4994630OtherBLUE CROSS BLUE SHIELD
MN86M76CAOtherBCBS
SD9203490Medicaid
U73168Medicare UPIN
MN86M76CAOtherBCBS