Provider Demographics
NPI:1144669904
Name:BEAVER, SARA FAULKENBERRY (OD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:FAULKENBERRY
Last Name:BEAVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:ALICE
Other - Last Name:FAULKENBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:204 LANGFORD RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8648
Mailing Address - Country:US
Mailing Address - Phone:803-714-1116
Mailing Address - Fax:803-714-1162
Practice Address - Street 1:204 LANGFORD RD
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8648
Practice Address - Country:US
Practice Address - Phone:803-714-1116
Practice Address - Fax:803-714-1162
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2329152W00000X
SC1754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist