Provider Demographics
NPI:1629562905
Name:MAXEY, SARAH ELIZABETH MARTINE (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH MARTINE
Last Name:MAXEY
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 1:7900 AIRWAYS BLVD BLDG A1
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-4116
Mailing Address - Country:US
Mailing Address - Phone:615-308-6040
Mailing Address - Fax:
Practice Address - Street 1:7900 AIRWAYS BLVD BLDG A1
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4116
Practice Address - Country:US
Practice Address - Phone:901-228-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3483152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist