Provider Demographics
NPI:1871116426
Name:UNDERWOOD, SARA ANN
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3858 FORTSON LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-5316
Mailing Address - Country:US
Mailing Address - Phone:334-408-4083
Mailing Address - Fax:
Practice Address - Street 1:3922A US HWY 80 WEST
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36870
Practice Address - Country:US
Practice Address - Phone:334-408-4083
Practice Address - Fax:334-408-0397
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic