Provider Demographics
NPI:1043424062
Name:SHERYL L. POTTER O.D., INC.
Entity Type:Organization
Organization Name:SHERYL L. POTTER O.D., INC.
Other - Org Name:OPTIC GALLERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-220-3937
Mailing Address - Street 1:7090 NORTH DURANGO DR. STE.110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149
Mailing Address - Country:US
Mailing Address - Phone:702-938-2020
Mailing Address - Fax:
Practice Address - Street 1:7090 NORTH DURANGO DR. STE.110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149
Practice Address - Country:US
Practice Address - Phone:702-220-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV317152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV104831Medicare PIN
NV5996090001Medicare NSC
NVV104830Medicare PIN
NVV100843Medicare PIN
NVG27392Medicare UPIN