Provider Demographics
NPI:1235359258
Name:COLE, SHERRI ALAINE (LDO)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:ALAINE
Last Name:COLE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-6841
Mailing Address - Country:US
Mailing Address - Phone:386-623-0514
Mailing Address - Fax:
Practice Address - Street 1:621 SW BAYA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-4240
Practice Address - Country:US
Practice Address - Phone:386-719-9292
Practice Address - Fax:386-754-6615
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4171156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630349800Medicaid