MEDICARE: SHERRY HIGGINBOTHAM O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TA1490	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013975796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY HIGGINBOTHAM O.D.

Provider Business Mailing Address
First Line	:	515 FAIRMOUNT AVE STE 400
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-8518
Country	:	US
Telephone Number	:	410-526-3060
Fax Number	:	410-584-2243

Provider Business Practice Location Address
First Line	:	750 MAIN ST STE 301A
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-2517
Country	:	US
Telephone Number	:	410-526-3060
Fax Number	:	410-584-2243

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	11/30/2020

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