Provider Demographics
NPI:1982697025
Name:SANFORD, KATHERINE DENTON (OD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:DENTON
Last Name:SANFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1689 NONCONNAH BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38132-2111
Mailing Address - Country:US
Mailing Address - Phone:901-523-8990
Mailing Address - Fax:901-522-3436
Practice Address - Street 1:1689 NONCONNAH BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-2111
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:901-577-7456
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3946268Medicaid
TN2441OtherOD
TNMS1158698OtherDEA
TN2441OtherOD
TN3946268Medicare ID - Type Unspecified