Provider Demographics
NPI:1407205610
Name:BOARD, SARAH ROSE (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ROSE
Last Name:BOARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:ROSE
Other - Last Name:PROSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3333 HAZELTON RD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4204
Mailing Address - Country:US
Mailing Address - Phone:952-926-6149
Mailing Address - Fax:
Practice Address - Street 1:3333 HAZELTON RD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4204
Practice Address - Country:US
Practice Address - Phone:952-926-6149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3473152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist