Healthcare Provider Details

I. General information

NPI: 1386473395
Provider Name (Legal Business Name): SARA BROWNING COOPER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 N VALDOSTA RD STE A
VALDOSTA GA
31602-4973
US

IV. Provider business mailing address

4120 N VALDOSTA RD STE A
VALDOSTA GA
31602-4973
US

V. Phone/Fax

Practice location:
  • Phone: 299-244-2068
  • Fax: 229-244-2850
Mailing address:
  • Phone: 229-244-2068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003585
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: