Provider Demographics
NPI:1295831410
Name:HAUSMAN, SHARI LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:SHARI
Middle Name:LYNN
Last Name:HAUSMAN
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 1:15 EAGLE RDG
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1357
Mailing Address - Country:US
Mailing Address - Phone:201-505-0151
Mailing Address - Fax:212-927-8600
Practice Address - Street 1:4250 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3748
Practice Address - Country:US
Practice Address - Phone:212-795-5640
Practice Address - Fax:212-927-6200
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005254-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01742736Medicaid