Healthcare Provider Details

I. General information

NPI: 1487184818
Provider Name (Legal Business Name): SARAH BLACKWELDER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 MANCHACA RD STE B
AUSTIN TX
78748-3786
US

IV. Provider business mailing address

12000 MANCHACA RD UNIT B
AUSTIN TX
78748-3785
US

V. Phone/Fax

Practice location:
  • Phone: 512-358-8200
  • Fax:
Mailing address:
  • Phone: 512-358-8200
  • Fax: 512-358-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33709TLG
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9882TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: