Provider Demographics
NPI:1073636502
Name:HARRISON, SHEILA ANN (OPTICIAN)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:ANN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6196
Mailing Address - Country:US
Mailing Address - Phone:518-561-7007
Mailing Address - Fax:
Practice Address - Street 1:450 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1755
Practice Address - Country:US
Practice Address - Phone:518-566-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8110156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician