Provider Demographics
NPI:1982795480
Name:SANDER, SCOTT T (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:T
Last Name:SANDER
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 1:12904 LARSEN ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-3467
Mailing Address - Country:US
Mailing Address - Phone:913-851-7886
Mailing Address - Fax:816-524-3415
Practice Address - Street 1:1850 NW CHIPMAN RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3938
Practice Address - Country:US
Practice Address - Phone:816-524-3369
Practice Address - Fax:816-524-3415
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03097152WC0802X
KSKS1343-3152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management