Provider Demographics
NPI:1174688816
Name:CARLOS, SALLY T (OD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:T
Last Name:CARLOS
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:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-0655
Mailing Address - Country:US
Mailing Address - Phone:413-283-2946
Mailing Address - Fax:
Practice Address - Street 1:1448 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1269
Practice Address - Country:US
Practice Address - Phone:413-283-2946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist