Provider Demographics
NPI:1033179361
Name:POWELL, SHARON BEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:BEAN
Last Name:POWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:L
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:140 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5509
Mailing Address - Country:US
Mailing Address - Phone:845-562-0138
Mailing Address - Fax:
Practice Address - Street 1:140 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5509
Practice Address - Country:US
Practice Address - Phone:845-562-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT0058831152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC305H1Medicare ID - Type Unspecified
U98340Medicare UPIN