Provider Demographics
NPI:1154346088
Name:PHELPS, SARA E (OD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:PHELPS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 GLYNN AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4406
Mailing Address - Country:US
Mailing Address - Phone:912-466-9500
Mailing Address - Fax:912-466-9922
Practice Address - Street 1:3303A GLYNN AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4406
Practice Address - Country:US
Practice Address - Phone:912-466-9500
Practice Address - Fax:912-466-9922
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3399OtherMEDICARE ID-TYPE UNSPECIF
GA00068307AMedicaid
GAGRP3399Medicare PIN
GA00068307AMedicaid
GAV09730Medicare UPIN