Provider Demographics
NPI:1164552030
Name:SHERWOOD OPTICAL STUDIO
Entity Type:Organization
Organization Name:SHERWOOD OPTICAL STUDIO
Other - Org Name:SHERWOOD OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURJOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-972-8900
Mailing Address - Street 1:1341 S POWERLINE RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4313
Mailing Address - Country:US
Mailing Address - Phone:954-972-8900
Mailing Address - Fax:954-971-0289
Practice Address - Street 1:1341 S POWERLINE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4313
Practice Address - Country:US
Practice Address - Phone:954-972-8900
Practice Address - Fax:954-971-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty