Provider Demographics
NPI:1710956115
Name:HARTER, SARA (OD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:HARTER
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:UNIT 8900 BOX 237
Mailing Address - Street 2:
Mailing Address - City:DPO
Mailing Address - State:AE
Mailing Address - Zip Code:09831-0237
Mailing Address - Country:US
Mailing Address - Phone:703-349-0544
Mailing Address - Fax:
Practice Address - Street 1:UNIT 8900 BOX 237
Practice Address - Street 2:
Practice Address - City:DPO
Practice Address - State:AE
Practice Address - Zip Code:09831-0237
Practice Address - Country:US
Practice Address - Phone:703-349-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001368152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2133392OtherMAMSI
VA249660OtherPHCS
VA9378577OtherUNITED HEATHCARE
VA177574OtherANTHEM BCBS
VA016747D71Medicare ID - Type Unspecified
VAV04523Medicare UPIN