Provider Demographics
NPI:1942201298
Name:SANCHEZ, CARLOS (OD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:SANCHEZ
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 1:8076 MEDITERRANEAN DR.
Mailing Address - Street 2:SUITE#115
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-8304
Mailing Address - Country:US
Mailing Address - Phone:239-992-7711
Mailing Address - Fax:239-992-9311
Practice Address - Street 1:8076 MEDITERRANEAN DR.
Practice Address - Street 2:SUITE#115
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-8304
Practice Address - Country:US
Practice Address - Phone:239-992-7711
Practice Address - Fax:239-992-9311
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620247100Medicaid
FL620247100Medicaid
FL207082Medicare ID - Type Unspecified