Provider Demographics
NPI:1073764817
Name:MARC H SHERMAN OD PA
Entity Type:Organization
Organization Name:MARC H SHERMAN OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-332-8255
Mailing Address - Street 1:1495 W STATE ROAD 434
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3861
Mailing Address - Country:US
Mailing Address - Phone:407-332-8255
Mailing Address - Fax:407-332-5769
Practice Address - Street 1:1495 W STATE ROAD 434
Practice Address - Street 2:SUITE 109
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-3861
Practice Address - Country:US
Practice Address - Phone:407-332-8255
Practice Address - Fax:407-332-5769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1051152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084456000Medicaid
FL084456000Medicaid
T84005Medicare UPIN
FLD04539Medicare PIN
FLB1303Medicare PIN