Provider Demographics
NPI:1699705632
Name:PIKE, SARA ELISABETH (OD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ELISABETH
Last Name:PIKE
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 1:430 POTTSTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-1423
Mailing Address - Country:US
Mailing Address - Phone:215-679-3500
Mailing Address - Fax:215-679-3096
Practice Address - Street 1:430 POTTSTOWN AVE
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-1423
Practice Address - Country:US
Practice Address - Phone:215-679-3500
Practice Address - Fax:215-679-3096
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPI184901Medicare ID - Type Unspecified
PAU69297Medicare UPIN