Provider Demographics
NPI:1467815126
Name:SANBORN OPTOMETRIC ASSOCIATES
Entity Type:Organization
Organization Name:SANBORN OPTOMETRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SANBORN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-756-0891
Mailing Address - Street 1:216 IRON ST
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1524
Mailing Address - Country:US
Mailing Address - Phone:617-756-0891
Mailing Address - Fax:
Practice Address - Street 1:900 HARTFORD-NEW LONDON TURNPIKE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-443-3178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2879261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service