Provider Demographics
NPI:1174688816
Name:CARLOS, SALLY T (OD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:T
Last Name:CARLOS
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 1:74 MILL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1537
Mailing Address - Country:US
Mailing Address - Phone:413-531-3125
Mailing Address - Fax:
Practice Address - Street 1:175 LITTLETON RD
Practice Address - Street 2:STE 13
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3120
Practice Address - Country:US
Practice Address - Phone:413-531-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist