Provider Demographics
NPI:1508084898
Name:STUBBLEFIELD, SARA PATRICIA (OD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:PATRICIA
Last Name:STUBBLEFIELD
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 1:289 CROSS COUNTRY LOOP
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3564
Mailing Address - Country:US
Mailing Address - Phone:614-898-3874
Mailing Address - Fax:
Practice Address - Street 1:4427 CROSSROADS CTR
Practice Address - Street 2:CO TODD CHONTOS OD
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4908
Practice Address - Country:US
Practice Address - Phone:614-963-0195
Practice Address - Fax:614-863-2701
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4319 T882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH4319OtherEYEMED
OHOH4319OtherEYEMED
OHST0779011Medicare PIN