Provider Demographics
NPI:1386378370
Name:DE SOTO, SARAH (OD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:DE SOTO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:HILEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 93631
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-3631
Mailing Address - Country:US
Mailing Address - Phone:863-651-8834
Mailing Address - Fax:
Practice Address - Street 1:4121 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3818
Practice Address - Country:US
Practice Address - Phone:863-859-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist