Provider Demographics
NPI:1275382103
Name:SANDERS, RUQUIYAH (LDO)
Entity type:Individual
Prefix:
First Name:RUQUIYAH
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 STALLINGS ST NW
Mailing Address - Street 2:UNIT 2971
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2351
Mailing Address - Country:US
Mailing Address - Phone:404-997-8422
Mailing Address - Fax:
Practice Address - Street 1:2131 STALLINGS ST NW
Practice Address - Street 2:UNIT 2971
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2351
Practice Address - Country:US
Practice Address - Phone:404-997-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002357156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician