Provider Demographics
NPI:1215043799
Name:POLING, SALLY R (OD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:R
Last Name:POLING
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 1:6580 W LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-4648
Mailing Address - Country:US
Mailing Address - Phone:812-379-9082
Mailing Address - Fax:
Practice Address - Street 1:1133 N EMERSON AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6275
Practice Address - Country:US
Practice Address - Phone:317-888-9038
Practice Address - Fax:317-888-9079
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U09497Medicare UPIN
IN796310Medicare ID - Type Unspecified