Provider Demographics
NPI:1053604397
Name:SANDERS, MATTHEW T (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:T
Last Name:SANDERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:MATT
Other - Middle Name:TERRY
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1209 32ND AVE SW APT 4
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-7268
Mailing Address - Country:US
Mailing Address - Phone:701-720-6379
Mailing Address - Fax:
Practice Address - Street 1:1209 32ND AVE SW
Practice Address - Street 2:APARTMENT 4
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-7268
Practice Address - Country:US
Practice Address - Phone:701-720-6379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND693152W00000X
MN3250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist