Provider Demographics
NPI:1134136849
Name:BOPP, SARA H (OD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:H
Last Name:BOPP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 HARRISON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7132
Mailing Address - Country:US
Mailing Address - Phone:864-654-6706
Mailing Address - Fax:864-343-2074
Practice Address - Street 1:273 HARRISON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7132
Practice Address - Country:US
Practice Address - Phone:864-654-6706
Practice Address - Fax:864-343-2074
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD09300Medicaid
SC7360Medicare ID - Type Unspecified
SCU10987Medicare UPIN