Provider Demographics
NPI:1689653800
Name:KLEINER-GOUDEY, SARA JANE (OD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:JANE
Last Name:KLEINER-GOUDEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:JANE
Other - Last Name:KLEINER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:217 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6837
Mailing Address - Country:US
Mailing Address - Phone:413-499-3797
Mailing Address - Fax:413-499-3834
Practice Address - Street 1:217 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6837
Practice Address - Country:US
Practice Address - Phone:413-499-3797
Practice Address - Fax:413-499-3834
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4093152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10084929OtherCDPHP
MA9770721Medicaid
W16344OtherBLUE CROSS BLUE SHIELD
MA461467OtherTUFTS
MA0000000-26985OtherBOSTON HEALTH NET
NY713662OtherMVP
MAAA27306OtherHARVARD
MA30690OtherHEALTH NEW ENGLAND
CT040903OtherCONNECTICARE
3727398OtherAETNA
W16344OtherBLUE CROSS BLUE SHIELD
MA9770721Medicaid