Provider Demographics
NPI:1972242774
Name:RESTUCCIO, SARA ASHLEY (OD)
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:ASHLEY
Last Name:RESTUCCIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:119 FOXBANK PLANTATION BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-6725
Mailing Address - Country:US
Mailing Address - Phone:437-616-4858
Mailing Address - Fax:
Practice Address - Street 1:119 FOXBANK PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-6725
Practice Address - Country:US
Practice Address - Phone:843-761-6485
Practice Address - Fax:843-761-6486
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC2341152W00000X
SCOPT.2341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist