Provider Demographics
NPI:1437268042
Name:OLMSCHENK, SARAH MARIE (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:OLMSCHENK
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 1:527 SE BASELINE ST
Mailing Address - Street 2:STE B
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4149
Mailing Address - Country:US
Mailing Address - Phone:503-648-8328
Mailing Address - Fax:503-648-8378
Practice Address - Street 1:527 SE BASELINE ST
Practice Address - Street 2:STE B
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4149
Practice Address - Country:US
Practice Address - Phone:503-648-8328
Practice Address - Fax:503-648-8378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3474ATI152W00000X
MN3068152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R170337Medicare PIN