Provider Demographics
NPI:1124020524
Name:MARTIN, SHERIDAN ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:SHERIDAN
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SHERIDAN
Other - Middle Name:ANN
Other - Last Name:RENOUF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2537 MELVILLE LN
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1140
Mailing Address - Country:US
Mailing Address - Phone:210-655-8545
Mailing Address - Fax:
Practice Address - Street 1:113 LIELMANIS AVE
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-5613
Practice Address - Country:US
Practice Address - Phone:850-884-3819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4865T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist