Provider Demographics
NPI:1114193828
Name:MARC R SANDERS MD PA
Entity Type:Organization
Organization Name:MARC R SANDERS MD PA
Other - Org Name:DIAGNOSTIC EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:713-797-1500
Mailing Address - Street 1:3405 EDLOE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6513
Mailing Address - Country:US
Mailing Address - Phone:713-797-1500
Mailing Address - Fax:713-797-1150
Practice Address - Street 1:1213 HERMANN DR STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7008
Practice Address - Country:US
Practice Address - Phone:713-797-1500
Practice Address - Fax:713-797-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6115TG152W00000X
TXJ3593207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4189260001Medicare NSC