Provider Demographics
NPI:1457343253
Name:MACKIE, SARAH SAPUTO (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:SAPUTO
Last Name:MACKIE
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 1:5106 MANATEE AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3739
Mailing Address - Country:US
Mailing Address - Phone:941-795-2020
Mailing Address - Fax:941-794-5918
Practice Address - Street 1:5106 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3739
Practice Address - Country:US
Practice Address - Phone:941-795-2020
Practice Address - Fax:941-794-5918
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOB2826152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620725101Medicaid
FL620725101Medicaid
FLU90776Medicare UPIN