Provider Demographics
NPI:1609887645
Name:BLATCHFORD, SARAH ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELIZABETH
Last Name:BLATCHFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:GROVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4906 HONONEGAH RD
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-7778
Mailing Address - Country:US
Mailing Address - Phone:815-623-3937
Mailing Address - Fax:815-623-8298
Practice Address - Street 1:4906 HONONEGAH RD
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-7778
Practice Address - Country:US
Practice Address - Phone:815-623-3937
Practice Address - Fax:815-623-8298
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009012152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
213526Medicare PIN
U67543Medicare UPIN
5771410001Medicare NSC