Provider Demographics
NPI:1629147566
Name:PRUSINSKI, SARA M (OD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:M
Last Name:PRUSINSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:M
Other - Last Name:LORENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3583 RESERVE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8180
Mailing Address - Country:US
Mailing Address - Phone:330-722-8300
Mailing Address - Fax:330-725-0445
Practice Address - Street 1:3583 RESERVE COMMONS DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8180
Practice Address - Country:US
Practice Address - Phone:330-722-8300
Practice Address - Fax:330-725-0445
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4979T1849152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5747830001Medicare NSC
OHU71392Medicare UPIN