Healthcare Provider Details

I. General information

NPI: 1912714056
Provider Name (Legal Business Name): HUNTER COLE SHERLOCK OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S IDAHO RD STE 160
APACHE JUNCTION AZ
85119-2318
US

IV. Provider business mailing address

682 N SUN RD
APACHE JUNCTION AZ
85119-8562
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-0241
  • Fax:
Mailing address:
  • Phone: 480-415-4076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002843
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: