Provider Demographics
NPI:1053594358
Name:DAY, SANDRA (LDO)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:DAY
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LDO
Mailing Address - Street 1:363 MAIN ST S
Mailing Address - Street 2:TIFT EYE CARE
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4813
Mailing Address - Country:US
Mailing Address - Phone:229-382-4441
Mailing Address - Fax:229-386-0211
Practice Address - Street 1:363 MAIN ST S
Practice Address - Street 2:TIFT EYE CARE
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4813
Practice Address - Country:US
Practice Address - Phone:229-382-4441
Practice Address - Fax:229-386-0211
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA479156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1176870001Medicare NSC