Provider Demographics
NPI:1851549224
Name:PAYTON, SANDRA M (OD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:PAYTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 TREMONT ST APT 506
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3426
Mailing Address - Country:US
Mailing Address - Phone:617-536-0931
Mailing Address - Fax:
Practice Address - Street 1:2038 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2104
Practice Address - Country:US
Practice Address - Phone:617-864-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4696152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist