Provider Demographics
NPI:1760251250
Name:SANDERS, KRISTY M (NCLDO, ABOC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
Credentials:NCLDO, ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 LEONARD AVE
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-5257
Mailing Address - Country:US
Mailing Address - Phone:704-983-2691
Mailing Address - Fax:704-983-2716
Practice Address - Street 1:781 LEONARD AVE
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5257
Practice Address - Country:US
Practice Address - Phone:704-983-2691
Practice Address - Fax:704-983-2716
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2084156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician