Provider Demographics
NPI:1548460751
Name:WISE, SARAH TIFFANY (OD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:TIFFANY
Last Name:WISE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:115 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRAPPE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2004
Mailing Address - Country:US
Mailing Address - Phone:610-831-8060
Mailing Address - Fax:610-831-8061
Practice Address - Street 1:115 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:TRAPPE
Practice Address - State:PA
Practice Address - Zip Code:19426-2004
Practice Address - Country:US
Practice Address - Phone:610-831-8060
Practice Address - Fax:610-831-8061
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG001957152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist