Provider Demographics
NPI:1104826536
Name:BASS, SHERRY J (OD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:J
Last Name:BASS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 IRVING PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1258
Mailing Address - Country:US
Mailing Address - Phone:516-295-1865
Mailing Address - Fax:
Practice Address - Street 1:8 IRVING PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1258
Practice Address - Country:US
Practice Address - Phone:516-295-1865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT003837152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT49128Medicare UPIN
NYC33651Medicare ID - Type Unspecified
NYC27921Medicare PIN