Provider Demographics
NPI:1346243318
Name:SCHRADER-MOORE, SANDRA (OD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SCHRADER-MOORE
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 1:202 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-3012
Mailing Address - Country:US
Mailing Address - Phone:336-248-2237
Mailing Address - Fax:336-249-7223
Practice Address - Street 1:202 W CENTER ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3012
Practice Address - Country:US
Practice Address - Phone:336-248-2237
Practice Address - Fax:336-249-7223
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7678536002OtherCIGNA
NC8909656Medicaid
NCNC1201OtherEYEMED
NC0921NOtherBCBS
NC2202170OtherUHC
NC33497OtherPARTNERS
NC8909656Medicaid
NCT65014Medicare UPIN