Healthcare Provider Details

I. General information

NPI: 1629170378
Provider Name (Legal Business Name): SHARON WOLFF O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CENTRAL AVE NE
COLUMBIA HEIGHTS MN
55421-2968
US

IV. Provider business mailing address

4000 CENTRAL AVE NE
COLUMBIA HEIGHTS MN
55421-2968
US

V. Phone/Fax

Practice location:
  • Phone: 763-788-9147
  • Fax: 763-782-8154
Mailing address:
  • Phone: 763-788-9147
  • Fax: 763-782-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMN2609
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number556
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: