Healthcare Provider Details

I. General information

NPI: 1154807295
Provider Name (Legal Business Name): SARAH ROTHLEY LUCAS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 NE 15TH AVE
PORTLAND OR
97212-2358
US

IV. Provider business mailing address

3605 NE 15TH AVE
PORTLAND OR
97212-2358
US

V. Phone/Fax

Practice location:
  • Phone: 734-730-2045
  • Fax:
Mailing address:
  • Phone: 734-730-2045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberAT-4372
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: