Provider Demographics
NPI:1073799136
Name:MARTIN, SARAH A (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5407 BRISTOL BEND CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-4002
Mailing Address - Country:US
Mailing Address - Phone:702-675-5935
Mailing Address - Fax:
Practice Address - Street 1:500 N RAINBOW BLVD STE 300-307
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107
Practice Address - Country:US
Practice Address - Phone:888-495-4489
Practice Address - Fax:602-865-8090
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1002152W00000X
OR3491AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500657725Medicaid
ORR170323Medicare UPIN