MEDICARE: DR. SARAH ROSE BOARD O.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3473	MN

General Provider Information

NPI Number	:	1407205610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH ROSE BOARD O.D

Provider Business Mailing Address
First Line	:	3333 HAZELTON RD
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-4204
Country	:	US
Telephone Number	:	952-926-6149
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 HAZELTON RD
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-4204
Country	:	US
Telephone Number	:	952-926-6149
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	10/24/2016

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