Provider Demographics
NPI:1164083143
Name:TAYLOR, SARA (OD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:MCVETY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:522 N NEW BALLAS RD STE 113
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6820
Mailing Address - Country:US
Mailing Address - Phone:314-567-7771
Mailing Address - Fax:314-567-7774
Practice Address - Street 1:522 N NEW BALLAS RD STE 113
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6820
Practice Address - Country:US
Practice Address - Phone:314-567-7771
Practice Address - Fax:314-567-7774
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019021359152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist