Provider Demographics
NPI:1952527236
Name:KANE, SARAH (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:KANE
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 1:12000 SE 82ND AVE
Mailing Address - Street 2:SUITE 1008
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7721
Mailing Address - Country:US
Mailing Address - Phone:503-654-6217
Mailing Address - Fax:
Practice Address - Street 1:12000 SE 82ND AVE
Practice Address - Street 2:SUITE 1008
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086-7721
Practice Address - Country:US
Practice Address - Phone:503-654-6217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2888ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR114597Medicare ID - Type Unspecified
ORU93413Medicare UPIN