Provider Demographics
NPI:1831263060
Name:SARA MABIE OD PA
Entity type:Organization
Organization Name:SARA MABIE OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MABIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:651-436-3763
Mailing Address - Street 1:1189 GENEVA AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5746
Mailing Address - Country:US
Mailing Address - Phone:651-702-2504
Mailing Address - Fax:651-731-7905
Practice Address - Street 1:1189 GENEVA AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5746
Practice Address - Country:US
Practice Address - Phone:651-702-2504
Practice Address - Fax:651-702-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2201213OtherMEDICA
MN39G01TAOtherBCBS MN
637371026225OtherPREFERRED ONE
964223OtherCOLE MANAGED VISION
637371016544OtherPREFERRED ONE
MN718317800Medicaid
MN84615OtherHEALTH PARTNERS
964223OtherCOLE MANAGED VISION
637371026225OtherPREFERRED ONE