Provider Demographics
NPI:1477555837
Name:SANDERS, CHARLES L JR (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:SANDERS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5035
Mailing Address - Country:US
Mailing Address - Phone:423-870-3742
Mailing Address - Fax:423-877-9494
Practice Address - Street 1:4511 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5035
Practice Address - Country:US
Practice Address - Phone:423-870-3742
Practice Address - Fax:423-877-9494
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD 1190152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0086164OtherBLUE CROSS
TN3596745Medicaid
2240045OtherUNITED HEALTHCARE
TN3596745Medicaid
U20685Medicare UPIN