Provider Demographics
NPI:1760978886
Name:SANDERS, DAVID ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:SANDERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:360 CENTRAL AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1604
Mailing Address - Country:US
Mailing Address - Phone:516-569-5644
Mailing Address - Fax:516-569-4601
Practice Address - Street 1:360 CENTRAL AVE STE 121
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1604
Practice Address - Country:US
Practice Address - Phone:516-569-5644
Practice Address - Fax:516-569-4601
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist