Provider Demographics
NPI:1154723997
Name:HAAKONSEN, SARAH REYES (OD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:REYES
Last Name:HAAKONSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SATAH
Other - Middle Name:REYES
Other - Last Name:HAAKONSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5461 LUIS DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4064
Mailing Address - Country:US
Mailing Address - Phone:818-807-2370
Mailing Address - Fax:
Practice Address - Street 1:16311 VENTURA BLVD STE 750
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4325
Practice Address - Country:US
Practice Address - Phone:818-990-3623
Practice Address - Fax:818-788-5601
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9567T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist