Provider Demographics
NPI:1013968965
Name:FRATESI, SARAH BARNES (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:BARNES
Last Name:FRATESI
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 1:14994 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-2616
Mailing Address - Country:US
Mailing Address - Phone:662-773-3494
Mailing Address - Fax:
Practice Address - Street 1:6 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-1901
Practice Address - Country:US
Practice Address - Phone:662-323-3330
Practice Address - Fax:662-323-3880
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01131571Medicaid
MS0443350001OtherPALMETTO
MS0443350001OtherPALMETTO
MSU97099Medicare UPIN
410000296Medicare PIN