Provider Demographics
NPI:1235141698
Name:MYRON, SARAH LYNN (OD)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LYNN
Last Name:MYRON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:LYNN
Other - Last Name:ENGSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:332 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4528
Mailing Address - Country:US
Mailing Address - Phone:701-642-7000
Mailing Address - Fax:701-642-7055
Practice Address - Street 1:332 2ND AVE N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4528
Practice Address - Country:US
Practice Address - Phone:701-642-7000
Practice Address - Fax:701-642-7055
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3055152W00000X
ND667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN713735Medicare PIN