Provider Demographics
NPI:1851943088
Name:REGAL, SARAH (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:REGAL
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 1:9826 GALLAGHER RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:FL
Mailing Address - Zip Code:33527-3610
Mailing Address - Country:US
Mailing Address - Phone:903-503-3187
Mailing Address - Fax:
Practice Address - Street 1:3802A BRITTON PLZ
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1406
Practice Address - Country:US
Practice Address - Phone:813-837-0077
Practice Address - Fax:813-839-8509
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5674152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist