Provider Demographics
NPI:1619046687
Name:RAST, SHERRI CHRISTINE (OD)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:CHRISTINE
Last Name:RAST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:SHERRI
Other - Middle Name:CHRISTINE
Other - Last Name:FAUVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1803 HARTNESS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5494
Mailing Address - Country:US
Mailing Address - Phone:361-688-7830
Mailing Address - Fax:
Practice Address - Street 1:419 SE MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2676
Practice Address - Country:US
Practice Address - Phone:864-417-2345
Practice Address - Fax:864-399-9519
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1964152W00000X
TX5396TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092998602Medicaid
U67488Medicare UPIN