Healthcare Provider Details

I. General information

NPI: 1407980436
Provider Name (Legal Business Name): DONNA SHERWOOD OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 BLACK RIVER BLVD N
ROME NY
13440-2454
US

IV. Provider business mailing address

1756 BLACK RIVER BLVD N
ROME NY
13440-2454
US

V. Phone/Fax

Practice location:
  • Phone: 315-339-3500
  • Fax:
Mailing address:
  • Phone: 315-339-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number5566
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: