Provider Demographics
NPI:1699804120
Name:DORFZAUN, SANDER SOL (OD)
Entity type:Individual
Prefix:DR
First Name:SANDER
Middle Name:SOL
Last Name:DORFZAUN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:850 OLD PIEDMONT RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5490
Mailing Address - Country:US
Mailing Address - Phone:770-422-3677
Mailing Address - Fax:770-422-5814
Practice Address - Street 1:850 OLD PIEDMONT RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5490
Practice Address - Country:US
Practice Address - Phone:770-422-3677
Practice Address - Fax:770-422-5814
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0866240001OtherMEDICARE DURABLE GOODS
GA00082607AMedicaid
GA580000223OtherRAILROAD MEDICARE
GA0866240001OtherMEDICARE DURABLE GOODS