Healthcare Provider Details

I. General information

NPI: 1881829448
Provider Name (Legal Business Name): SARAH EMMETT BORTZ O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH A EMMETT O.D.

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 SAN PEDRO DR NE SUITE 220
ALBUQUERQUE NM
87113-2476
US

IV. Provider business mailing address

PO BOX 1506
CHEHALIS WA
98532-0409
US

V. Phone/Fax

Practice location:
  • Phone: 505-797-4466
  • Fax: 505-797-2275
Mailing address:
  • Phone: 360-242-3008
  • Fax: 360-807-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60232648
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number615
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: