Provider Demographics
NPI:1467624643
Name:MABIE, SARA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ANN
Last Name:MABIE
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1189 GENEVA AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5746
Mailing Address - Country:US
Mailing Address - Phone:651-702-2504
Mailing Address - Fax:651-731-7905
Practice Address - Street 1:1189 GENEVA N AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5746
Practice Address - Country:US
Practice Address - Phone:651-702-2504
Practice Address - Fax:651-731-7905
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22-01213OtherMEDICA
MN718317800Medicaid
MN39G02MAOtherBCBS MN
964223OtherCOLE MANAGED VISION
MN637371016544OtherPREFERRED ONE
MN637371026225OtherPREFERRED ONE
MNHP23634OtherHEALTH PARTNERS
MN718317800Medicaid
MN410001751Medicare PIN