Healthcare Provider Details

I. General information

NPI: 1760445449
Provider Name (Legal Business Name): SUSAN T DISARIO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN T. DISARIO O.D.

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 OKATIE CTR BLVD SUITE 102
BLUFFTON SC
29909-7529
US

IV. Provider business mailing address

4720 WATERS AVE
SAVANNAH GA
31404-6292
US

V. Phone/Fax

Practice location:
  • Phone: 843-705-3333
  • Fax: 843-705-3334
Mailing address:
  • Phone: 912-354-4800
  • Fax: 912-629-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1048
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: