Provider Demographics
NPI:1740271832
Name:ITO, SARAH (OD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:ITO
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 1:2605 LINCOLN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4619
Mailing Address - Country:US
Mailing Address - Phone:310-452-1039
Mailing Address - Fax:855-450-1039
Practice Address - Street 1:2605 LINCOLN BOULEVARD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-4619
Practice Address - Country:US
Practice Address - Phone:310-452-1039
Practice Address - Fax:855-450-1039
Is Sole Proprietor?:No
Enumeration Date:2005-10-29
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10084T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0100840Medicaid
CASD0100840Medicaid