Provider Demographics
NPI:1104560523
Name:MASTROROCCO, SARAH (OD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MASTROROCCO
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:WV
Mailing Address - Zip Code:26150-6779
Mailing Address - Country:US
Mailing Address - Phone:304-615-3764
Mailing Address - Fax:
Practice Address - Street 1:201 EDDIE CHASTEEN DR
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-5728
Practice Address - Country:US
Practice Address - Phone:843-699-8145
Practice Address - Fax:843-549-0104
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist