Provider Demographics
NPI:1093830630
Name:JOHN P SHELDON OD PA
Entity Type:Organization
Organization Name:JOHN P SHELDON OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-743-2020
Mailing Address - Street 1:6400 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2786
Mailing Address - Country:US
Mailing Address - Phone:305-743-2020
Mailing Address - Fax:395-743-3937
Practice Address - Street 1:6400 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2786
Practice Address - Country:US
Practice Address - Phone:305-743-2020
Practice Address - Fax:395-743-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3277152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620524100Medicaid
FL620524100Medicaid
FLU80330Medicare UPIN