Provider Demographics
NPI:1215683750
Name:LOUALLEN, SARAH KATHRYN (OPTICIAN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHRYN
Last Name:LOUALLEN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4270 BOOMER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7912
Mailing Address - Country:US
Mailing Address - Phone:513-260-1286
Mailing Address - Fax:513-557-2972
Practice Address - Street 1:2322 FERGUSON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3503
Practice Address - Country:US
Practice Address - Phone:513-922-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP6419SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician