Provider Demographics
NPI:1134152796
Name:VANWAY, SARAH (OD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:VANWAY
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 1:7717 N ORANGE PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-9323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WOLFE FAMILY VISION CENTER
Practice Address - Street 2:100 S. 23RD STREET
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556
Practice Address - Country:US
Practice Address - Phone:641-472-6151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist