Provider Demographics
NPI:1932103470
Name:SASSER, CARL DAVID (OD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:DAVID
Last Name:SASSER
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 1:11362 OLD US HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-9841
Mailing Address - Country:US
Mailing Address - Phone:336-764-2449
Mailing Address - Fax:336-764-4156
Practice Address - Street 1:11362 OLD US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-9841
Practice Address - Country:US
Practice Address - Phone:336-764-2449
Practice Address - Fax:336-764-4156
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1090152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909807Medicaid
NC246400BMedicare PIN
NC8909807Medicaid
NCT64937Medicare UPIN
NC0827850001Medicare NSC