Provider Demographics
NPI:1437532793
Name:MARIETTA, SARAH BURCH (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:BURCH
Last Name:MARIETTA
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 1:220 N MCKEMY AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2651
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-893-8172
Practice Address - Street 1:2222 E CAMELBACK RD STE 250M
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3427
Practice Address - Country:US
Practice Address - Phone:602-840-3501
Practice Address - Fax:602-840-3671
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3244152W00000X
AZOPT-002527152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist