Provider Demographics
NPI:1992924682
Name:SACKS WILNER, DORIS ALLISON (OD)
Entity type:Individual
Prefix:DR
First Name:DORIS
Middle Name:ALLISON
Last Name:SACKS WILNER
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 1:1901 NORTH OLDEN AVE
Mailing Address - Street 2:SUITE 27A
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618
Mailing Address - Country:US
Mailing Address - Phone:609-883-8989
Mailing Address - Fax:609-883-1373
Practice Address - Street 1:1901 NORTH OLDEN AVE
Practice Address - Street 2:SUITE 27A
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618
Practice Address - Country:US
Practice Address - Phone:609-883-8989
Practice Address - Fax:609-883-1373
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00287700152W00000X
NJ27T000046100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2570807Medicaid
NJSA521308Medicare ID - Type Unspecified
U26857Medicare UPIN