Provider Demographics
NPI:1336135086
Name:SANDERS, THOMAS W (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:SANDERS
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 1:1215 PLUMAS ST
Mailing Address - Street 2:STE 1100
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3455
Mailing Address - Country:US
Mailing Address - Phone:530-671-2822
Mailing Address - Fax:530-671-1450
Practice Address - Street 1:1215 PLUMAS ST
Practice Address - Street 2:STE 1100
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3455
Practice Address - Country:US
Practice Address - Phone:530-671-2822
Practice Address - Fax:530-671-1450
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0002980Medicaid
CADM117ZMedicare PIN
CASD0002980Medicaid
CAT10056Medicare UPIN
CASD0055930Medicare PIN