Provider Demographics
NPI:1881472231
Name:SANBORN, SAMANTHA (OD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:SANBORN
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 1:485 ROUTE 1 SOUTH
Mailing Address - Street 2:BUILDING A
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830
Mailing Address - Country:US
Mailing Address - Phone:732-750-0400
Mailing Address - Fax:
Practice Address - Street 1:485 ROUTE 1 SOUTH, BUILDING A
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830
Practice Address - Country:US
Practice Address - Phone:732-750-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRT009905152W00000X
NJ27OA00723500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist