Provider Demographics
NPI:1508834813
Name:HEMMINGSON, SARAH MAROSSY (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MAROSSY
Last Name:HEMMINGSON
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:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877
Mailing Address - Country:US
Mailing Address - Phone:208-773-7434
Mailing Address - Fax:208-777-0836
Practice Address - Street 1:185 W 4TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5089
Practice Address - Country:US
Practice Address - Phone:208-773-7434
Practice Address - Fax:208-777-0836
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID100023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806645500Medicaid
IDU81141Medicare UPIN
ID806645500Medicaid
ID6206340001Medicare NSC