Provider Demographics
NPI:1649321340
Name:SANDERS, DANIEL L (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
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 1:11780 SAN PABLO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2231
Mailing Address - Country:US
Mailing Address - Phone:510-234-1730
Mailing Address - Fax:510-234-8841
Practice Address - Street 1:11780 SAN PABLO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2231
Practice Address - Country:US
Practice Address - Phone:510-234-1730
Practice Address - Fax:510-234-8841
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4568T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0045680Medicaid
CASD0045680Medicaid
CAT09700Medicare UPIN