Provider Demographics
NPI:1720714785
Name:CLISHAM, SARAH OLIVIA
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:OLIVIA
Last Name:CLISHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 ASHFORD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3536
Mailing Address - Country:US
Mailing Address - Phone:484-388-3000
Mailing Address - Fax:
Practice Address - Street 1:244 N QUEEN ST FL 2
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-3512
Practice Address - Country:US
Practice Address - Phone:717-735-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003938152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist