Provider Demographics
NPI:1366499030
Name:O'CONNOR, SARA E (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:E
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1306 KANAWHA BLVD E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-3001
Mailing Address - Country:US
Mailing Address - Phone:304-343-4371
Mailing Address - Fax:304-353-0215
Practice Address - Street 1:1306 KANAWHA BLVD E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-3001
Practice Address - Country:US
Practice Address - Phone:304-343-4371
Practice Address - Fax:304-353-0215
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WVWV20834207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3003055000Medicaid
WV3003055000Medicaid
WVH70824Medicare UPIN