Provider Demographics
NPI:1578811493
Name:COLE, SADIE (OD)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:
Other - Last Name:DAAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17810 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2308
Mailing Address - Country:US
Mailing Address - Phone:308-643-9372
Mailing Address - Fax:402-697-5153
Practice Address - Street 1:17810 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2308
Practice Address - Country:US
Practice Address - Phone:308-643-9372
Practice Address - Fax:402-697-5153
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1375152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist