Active NPI
Mark Douglas Sanders, O.D.
- Optometrist
- Selinsgrove, PA
National Provider Identifier
1518423565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OETO8732
- Practice address
- 217 Sweet Gum Road
Selinsgrove, PA 17870 - Phone
- (570) 492-6644
- NPI assigned
- Feb 14, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OETO8732 | PA | Primary |
Addresses
Primary practice location
217 Sweet Gum Road
Selinsgrove, PA 17870
Mailing address
217 Sweet Gum Road
Selinsgrove, PA 17870
Phone (570) 492-6644
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OETO8732 | PA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550102400000",
"number": "1518423565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 SWEET GUM ROAD",
"city": "SELINSGROVE",
"state": "PA",
"postal_code": "17870",
"telephone_number": "570-492-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 SWEET GUM ROAD",
"city": "SELINSGROVE",
"state": "PA",
"postal_code": "17870",
"telephone_number": "570-492-6644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDERS",
"first_name": "MARK",
"middle_name": "DOUGLAS",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-14",
"last_updated": "2019-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "PA",
"license": "OETO8732",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Selinsgrove, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.