Provider Demographics
NPI:1003992652
Name:SHEERE-GALLATIN, DEBORAH ANN (OD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:SHEERE-GALLATIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7192 SETTERS POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6703
Mailing Address - Country:US
Mailing Address - Phone:810-733-7111
Mailing Address - Fax:810-733-7141
Practice Address - Street 1:4499 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3425
Practice Address - Country:US
Practice Address - Phone:810-733-7111
Practice Address - Fax:810-733-7141
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003836152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3463703Medicaid
MIU64254Medicare UPIN
MI0M97510Medicare ID - Type Unspecified