Provider Demographics
NPI:1306114020
Name:SALL, ELIZABETH ANN (OD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:SALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2123 71ST ST
Mailing Address - Street 2:3R
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1000
Mailing Address - Country:US
Mailing Address - Phone:504-323-4757
Mailing Address - Fax:
Practice Address - Street 1:2123 71ST ST
Practice Address - Street 2:3R
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1000
Practice Address - Country:US
Practice Address - Phone:504-323-4757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6097152W00000X
NJ27OA00671800152W00000X
MDTA2786152W00000X
MN3850152W00000X
PAOEG004197152W00000X
NYTUV008538152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist