Provider Demographics
NPI:1528268893
Name:SHEETS, SARA ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELIZABETH
Last Name:SHEETS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:RONDEAU BOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9701 NE 108TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3384
Mailing Address - Country:US
Mailing Address - Phone:360-216-9172
Mailing Address - Fax:
Practice Address - Street 1:9701 NE 108TH CT
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-3384
Practice Address - Country:US
Practice Address - Phone:360-216-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00004154152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
OR3225ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2033595Medicaid
WA8868267Medicare PIN