Provider Demographics
NPI:1164524716
Name:SANDERS, CARMOLY T (OD)
Entity Type:Individual
Prefix:DR
First Name:CARMOLY
Middle Name:T
Last Name:SANDERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-991-0514
Practice Address - Street 1:4412 MITCHELLVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3112
Practice Address - Country:US
Practice Address - Phone:301-809-0000
Practice Address - Fax:301-809-6004
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1639152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU94688Medicare UPIN
DC011251E22Medicare PIN
MD747LF565Medicare PIN