Provider Demographics
NPI:1043940992
Name:HARRIS, SHERI DAWN
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:DAWN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-1102
Mailing Address - Country:US
Mailing Address - Phone:270-527-1348
Mailing Address - Fax:
Practice Address - Street 1:310 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-1102
Practice Address - Country:US
Practice Address - Phone:270-527-1348
Practice Address - Fax:270-527-9593
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician