Individual
DR. SHANE RYAN SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3192 WILLOW CREEK RD, PRESCOTT, AZ 86301-6610
(928) 445-1234
Mailing address
345 S VIRGINIA ST UNIT 11, PRESCOTT, AZ 86303-4469
(928) 308-0275
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT-002281
AZ
Other
Enumeration date
07/13/2018
Last updated
07/13/2018
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