Healthcare Provider Details

I. General information

NPI: 1720943293
Provider Name (Legal Business Name): SHERYL HOOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 ROSADA DR
CHARLOTTE NC
28213-5955
US

IV. Provider business mailing address

1124 ROSADA DR
CHARLOTTE NC
28213-5955
US

V. Phone/Fax

Practice location:
  • Phone: 980-219-3402
  • Fax:
Mailing address:
  • Phone: 980-219-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number2057
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: