Provider Demographics
NPI:1225061377
Name:PAIKOWSKY, SARAH JANE (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JANE
Last Name:PAIKOWSKY
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 1:5514 E ALAN LN
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1162
Mailing Address - Country:US
Mailing Address - Phone:480-570-9078
Mailing Address - Fax:480-315-3791
Practice Address - Street 1:12801 W BELL RD
Practice Address - Street 2:SUITE 12
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9797
Practice Address - Country:US
Practice Address - Phone:623-583-0377
Practice Address - Fax:623-583-0378
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ539554Medicaid
AZ86-0967053OtherEIN
AZ539554Medicaid
T92425Medicare UPIN