Provider Demographics
NPI:1619973112
Name:SYDNOR, CARL W (OD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:W
Last Name:SYDNOR
Suffix:
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 1:732 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1234
Mailing Address - Country:US
Mailing Address - Phone:270-422-4241
Mailing Address - Fax:270-422-5211
Practice Address - Street 1:732 HIGH ST
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1234
Practice Address - Country:US
Practice Address - Phone:270-422-4241
Practice Address - Fax:270-422-5211
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1192DT152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy