Provider Demographics
NPI:1285470278
Name:ELDRIDGE, SARA JEAN (OD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:ELDRIDGE
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 1:220 STONEMARKER DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-7222
Mailing Address - Country:US
Mailing Address - Phone:270-402-7102
Mailing Address - Fax:
Practice Address - Street 1:130 THOMPSON POYNTER RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7280
Practice Address - Country:US
Practice Address - Phone:606-878-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2410DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist