Healthcare Provider Details

I. General information

NPI: 1083902845
Provider Name (Legal Business Name): SARAH KAY HANSEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH KAY HEBERT O.D.

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 28TH ST SE
GRAND RAPIDS MI
49512-2049
US

IV. Provider business mailing address

1340 BARBARA ST NW
GRAND RAPIDS MI
49544-1704
US

V. Phone/Fax

Practice location:
  • Phone: 616-233-4403
  • Fax: 616-233-4429
Mailing address:
  • Phone: 906-235-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004641
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: