Provider Demographics
NPI:1386641264
Name:SANDERSON, GAIL (OD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:SANDERSON
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 1:5426 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-2261
Mailing Address - Country:US
Mailing Address - Phone:419-726-1541
Mailing Address - Fax:419-726-7222
Practice Address - Street 1:5198 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-2748
Practice Address - Country:US
Practice Address - Phone:419-726-1541
Practice Address - Fax:419-726-7222
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6472000001Medicare NSC
OH5414 T2325Medicare UPIN
OHSA4146682Medicare PIN
OHP00865210Medicare PIN