Provider Demographics
NPI:1386138246
Name:JOHNSON, SARAH MAUREEN
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MAUREEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MAUREEN
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13700 W 67TH CIR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-2013
Mailing Address - Country:US
Mailing Address - Phone:607-425-1208
Mailing Address - Fax:
Practice Address - Street 1:4251 KIPLING ST UNIT 405
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6833
Practice Address - Country:US
Practice Address - Phone:303-932-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008759152WV0400X
CO0003533152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty