Provider Demographics
NPI:1265663173
Name:BROOKS, SHERI LYNN (ABOC,COA,RA)
Entity Type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:LYNN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:ABOC,COA,RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5574 SE ASH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1247
Mailing Address - Country:US
Mailing Address - Phone:503-260-8591
Mailing Address - Fax:503-236-5049
Practice Address - Street 1:5574 SE ASH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1247
Practice Address - Country:US
Practice Address - Phone:503-260-8591
Practice Address - Fax:503-236-5049
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR96750156FX1101X
OR22027156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant