Healthcare Provider Details

I. General information

NPI: 1063246858
Provider Name (Legal Business Name): SABRINA LEE WALKER NCLEC, ABOC, LDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 N FRASER ST
GEORGETOWN SC
29440-2800
US

IV. Provider business mailing address

1310 N FRASER ST
GEORGETOWN SC
29440-2800
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-8946
  • Fax: 843-527-5019
Mailing address:
  • Phone: 843-546-8946
  • Fax: 843-527-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP1.1443A
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: