Provider Demographics
NPI:1598836744
Name:WEES, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WEES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 120TH PL SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9208
Mailing Address - Country:US
Mailing Address - Phone:425-316-9880
Mailing Address - Fax:
Practice Address - Street 1:13119 SEATTLE HILL RD
Practice Address - Street 2:BLDG 1 STE 102
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-3400
Practice Address - Country:US
Practice Address - Phone:425-332-2276
Practice Address - Fax:425-948-7892
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003316152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8858234Medicare PIN