Provider Demographics
NPI:1649440793
Name:SANDY, MICHAEL MORRIS (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MORRIS
Last Name:SANDY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8405 SHADY ELM DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-0437
Mailing Address - Country:US
Mailing Address - Phone:901-219-3453
Mailing Address - Fax:
Practice Address - Street 1:3775 HACKS CROSS RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2302
Practice Address - Country:US
Practice Address - Phone:901-214-0065
Practice Address - Fax:901-214-0066
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN2015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist