Provider Demographics
NPI:1063106177
Name:SMITH, SARAH A (LDO)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2160 JOHN WAYLAND HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-4509
Mailing Address - Country:US
Mailing Address - Phone:540-438-0982
Mailing Address - Fax:540-438-0723
Practice Address - Street 1:2160 JOHN WAYLAND HWY
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-4509
Practice Address - Country:US
Practice Address - Phone:540-438-0982
Practice Address - Fax:540-438-0723
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA1101004000156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician