Provider Demographics
NPI:1710015029
Name:SWANSON, SARAH M (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:SWANSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:M
Other - Last Name:HARSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:808 J ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-2503
Mailing Address - Country:US
Mailing Address - Phone:916-447-3000
Mailing Address - Fax:916-447-3043
Practice Address - Street 1:808 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2503
Practice Address - Country:US
Practice Address - Phone:916-447-3000
Practice Address - Fax:916-447-3043
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV01903Medicare UPIN