Provider Demographics
NPI:1083902845
Name:HANSEN, SARAH KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:KAY
Last Name:HANSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:KAY
Other - Last Name:HEBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1340 BARBARA ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-1704
Mailing Address - Country:US
Mailing Address - Phone:906-235-0433
Mailing Address - Fax:
Practice Address - Street 1:5100 28TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2049
Practice Address - Country:US
Practice Address - Phone:616-233-4403
Practice Address - Fax:616-233-4429
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004641152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist