Healthcare Provider Details

I. General information

NPI: 1245366582
Provider Name (Legal Business Name): SARA ANNE CAMBURN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 28TH ST SE
GRAND RAPIDS MI
49512-1610
US

IV. Provider business mailing address

3536 S FRANCIS RD
SAINT JOHNS MI
48879-9570
US

V. Phone/Fax

Practice location:
  • Phone: 616-974-2020
  • Fax:
Mailing address:
  • Phone: 989-506-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004407
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: