Provider Demographics
NPI:1437237385
Name:SHOCKNEY, SARA E (OD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:E
Last Name:SHOCKNEY
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 1:153 RACHEL RD
Mailing Address - Street 2:
Mailing Address - City:RIDGE SPRING
Mailing Address - State:SC
Mailing Address - Zip Code:29129-9559
Mailing Address - Country:US
Mailing Address - Phone:803-587-1903
Mailing Address - Fax:
Practice Address - Street 1:121 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-8016
Practice Address - Country:US
Practice Address - Phone:803-532-3203
Practice Address - Fax:803-532-3386
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007116152W00000X
OHT2694152W00000X
OH5780152W00000X
SC1687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD16873Medicaid
SCAA8890Medicare UPIN
OH4256271Medicare PIN
OH4256272Medicare PIN