Provider Demographics
NPI:1609446400
Name:SANDERS, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10767 E CARSON CITY RD
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-8605
Mailing Address - Country:US
Mailing Address - Phone:989-584-3077
Mailing Address - Fax:
Practice Address - Street 1:7010 E BOGART RD
Practice Address - Street 2:
Practice Address - City:HUBBARDSTON
Practice Address - State:MI
Practice Address - Zip Code:48845-9321
Practice Address - Country:US
Practice Address - Phone:989-763-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1527859Medicaid