Healthcare Provider Details

I. General information

NPI: 1215195201
Provider Name (Legal Business Name): TARA LYNN STANLEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA LYNN SARNOWSKI-STANLEY O.D.

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 LONG POINT RD UNIT H2
MT PLEASANT SC
29464-8309
US

IV. Provider business mailing address

644 LONG POINT RD UNIT H2
MT PLEASANT SC
29464-8309
US

V. Phone/Fax

Practice location:
  • Phone: 843-920-3433
  • Fax: 854-205-2257
Mailing address:
  • Phone: 843-920-3433
  • Fax: 854-205-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001293
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2508
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: