Provider Demographics
NPI:1881829448
Name:BORTZ, SARAH EMMETT (OD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:EMMETT
Last Name:BORTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:EMMETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:8220 SAN PEDRO DR NE
Practice Address - Street 2:SUITE 220
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2476
Practice Address - Country:US
Practice Address - Phone:505-797-4466
Practice Address - Fax:505-797-2275
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60232648152W00000X
NM615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM303413OtherMEDICARE NM
NM29204860Medicaid