Provider Demographics
NPI:1669464970
Name:SANDERSON, JEFFREY PAUL (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:PAUL
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5137 GUS YOUNG LANE
Mailing Address - Street 2:SANDERSON EYE SPECIALISTS
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436
Mailing Address - Country:US
Mailing Address - Phone:952-641-6226
Mailing Address - Fax:952-641-6229
Practice Address - Street 1:5137 GUS YOUNG LANE
Practice Address - Street 2:SANDERSON EYE SPECIALISTS
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436
Practice Address - Country:US
Practice Address - Phone:952-641-6226
Practice Address - Fax:952-641-6229
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2015-07-31
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Provider Licenses
StateLicense IDTaxonomies
MO200513762174400000X
MN44481207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNI36977Medicare UPIN
MO11480837Medicare ID - Type Unspecified