=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811628514
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERRI SUE SUTTON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2022
-----------------------------------------------------
Last Update Date | 06/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 LETTON DR
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40361-2252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-987-4686
-----------------------------------------------------
Fax | 859-987-4680
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 755 BETHLEHEM RD
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40361-9059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-707-0193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 165971
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------