Provider Demographics
NPI:1477680544
Name:PAYNE, SANDY KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:KAY
Last Name:PAYNE
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 1:9750 SOUTH BANK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470
Mailing Address - Country:US
Mailing Address - Phone:541-673-0212
Mailing Address - Fax:
Practice Address - Street 1:2282 NW TROOST ST STE 104
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-6072
Practice Address - Country:US
Practice Address - Phone:541-672-7428
Practice Address - Fax:541-672-7430
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1559T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist