MEDICARE: DR. SARAH SAPUTO MACKIE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OB2826	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457343253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH SAPUTO MACKIE OD

Provider Business Mailing Address
First Line	:	5106 MANATEE AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-3739
Country	:	US
Telephone Number	:	941-795-2020
Fax Number	:	941-794-5918

Provider Business Practice Location Address
First Line	:	5106 MANATEE AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-3739
Country	:	US
Telephone Number	:	941-795-2020
Fax Number	:	941-794-5918

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	07/22/2008

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