1093790131 NPI number — DR. SAMUEL SANTANDER MD

Table of content: DR. SAMUEL SANTANDER MD (NPI 1093790131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093790131 NPI number — DR. SAMUEL SANTANDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTANDER
Provider First Name:
SAMUEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093790131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1070
Provider Second Line Business Mailing Address:
CHRISTENBURY EYE CENTER
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28201-1070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-332-9365
Provider Business Mailing Address Fax Number:
704-364-7384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3621 RANDOLPH ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-332-9365
Provider Business Practice Location Address Fax Number:
704-364-7384
Provider Enumeration Date:
12/13/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  9800380 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N00380 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8922463 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1109W . This is a "BCBS/NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7085246 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".