=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861455941
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON L YURKO O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2006
-----------------------------------------------------
Last Update Date | 11/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8246 LAGUNA BLVD SUITE 300
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95758-7968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-684-6688
-----------------------------------------------------
Fax | 916-684-6721
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 BENTLEY AVE
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95823-2431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-395-8776
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 8359T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------