Provider Demographics
NPI:1487184818
Name:BLACKWELDER, SARAH (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BLACKWELDER
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 1:5601 BRODIE LN STE 530
Mailing Address - Street 2:
Mailing Address - City:SUNSET VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2539
Mailing Address - Country:US
Mailing Address - Phone:512-358-8200
Mailing Address - Fax:
Practice Address - Street 1:5601 BRODIE LN STE 530
Practice Address - Street 2:
Practice Address - City:SUNSET VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78745-2539
Practice Address - Country:US
Practice Address - Phone:512-358-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33709TLG152W00000X
TX9882TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist