1346243318 NPI number — SANDRA SCHRADER-MOORE OD

Table of content: SANDRA SCHRADER-MOORE OD (NPI 1346243318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346243318 NPI number — SANDRA SCHRADER-MOORE OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHRADER-MOORE
Provider First Name:
SANDRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

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:
1346243318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 W CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27292-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-248-2237
Provider Business Mailing Address Fax Number:
336-249-7223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 W CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27292-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-248-2237
Provider Business Practice Location Address Fax Number:
336-249-7223
Provider Enumeration Date:
05/24/2005

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: 152W00000X , with the licence number:  1201 , 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: 7678536002 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8909656 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NC1201 . This is a "EYEMED" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0921N . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2202170 . This is a "UHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 33497 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".