Roberts, Mallory Sanderfur

Roberts, Mallory Sanderfur is an sole proprietor health care provider with primary practice located at 255 Main St , Calhoun KY 42327-2104. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Roberts, Mallory Sanderfur can be contacted via phone (270) 273-3000.

Contact Information

Primary practice address
255 Main St Calhoun KY 42327-2104
Fax: (270) 273-9252
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 1421DT Kentucky

Profile Details

NPI number 1679668198
LBN Legal business name Roberts, Mallory Sanderfur
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 3rd, 2006
Last updated Jun 18th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679668198 NPPES
Kentucky MEDICAID 77903375
Kentucky MEDICAID 77014215

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