Provider Demographics
NPI:1609286038
Name:BRICKER, SARAH JO (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JO
Last Name:BRICKER
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 1:815 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-0507
Mailing Address - Country:US
Mailing Address - Phone:270-524-5444
Mailing Address - Fax:270-524-4600
Practice Address - Street 1:815 MAIN ST.
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-0507
Practice Address - Country:US
Practice Address - Phone:270-524-5444
Practice Address - Fax:270-524-4600
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1971DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000542753OtherANTHEM
KY7100010580Medicaid
KY1971DTOtherKY LICENSE
KY000000542753OtherANTHEM
KY7100010580Medicaid
KY1971DTOtherKY LICENSE