Provider Demographics
NPI:1801102280
Name:SANFORD, AMANDA M (OD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:M
Last Name:SANFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12331 SW 3RD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-2815
Mailing Address - Country:US
Mailing Address - Phone:954-908-3937
Mailing Address - Fax:954-903-4176
Practice Address - Street 1:12331 SW 3RD ST STE 300
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-2815
Practice Address - Country:US
Practice Address - Phone:954-908-3937
Practice Address - Fax:954-903-4176
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5347152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114222800Medicaid