Individual
DR. MALLORY SANDERFUR ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
255 MAIN ST, CALHOUN, KY 42327-2104
(270) 273-3000
(270) 273-9252
Mailing address
PO BOX 411, CALHOUN, KY 42327-0411
(270) 273-3000
(270) 273-9252
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1421DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77014215
—
KY
05
—
77903375
—
KY
Enumeration date
10/03/2006
Last updated
06/18/2014
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