Provider Demographics
NPI:1255434460
Name:SANDERS, KATHERINE LYNNE (OD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LYNNE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3821 PROMENADE PKWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-5374
Mailing Address - Country:US
Mailing Address - Phone:228-392-8141
Mailing Address - Fax:228-392-8181
Practice Address - Street 1:3821 PROMENADE PKWY
Practice Address - Street 2:SUITE F
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-5374
Practice Address - Country:US
Practice Address - Phone:228-392-8141
Practice Address - Fax:228-392-8181
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS728152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSMS1402596OtherDEA NUMBER