Provider Demographics
NPI:1275684409
Name:SANDS, ALAN NEIL (OD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:NEIL
Last Name:SANDS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8641 W FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0632
Mailing Address - Country:US
Mailing Address - Phone:208-378-8989
Mailing Address - Fax:
Practice Address - Street 1:8641 W FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0632
Practice Address - Country:US
Practice Address - Phone:562-861-0444
Practice Address - Fax:562-923-1484
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100504152W00000X
CA6340T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU13909Medicare UPIN
CAWOP6340Medicare ID - Type Unspecified