Provider Demographics
NPI:1942282702
Name:LANE, SARAH (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:LANE
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 1:910 E COUNTY LINE RD
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2031
Mailing Address - Country:US
Mailing Address - Phone:732-966-3839
Mailing Address - Fax:
Practice Address - Street 1:910 E COUNTY LINE RD
Practice Address - Street 2:SUITE 102B
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2031
Practice Address - Country:US
Practice Address - Phone:732-966-3839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006908152W00000X
VT030-0000343152W00000X
NJ27OA00610300152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV06823Medicare UPIN
NYC414E1Medicare ID - Type Unspecified