Provider Demographics
NPI:1356317770
Name:WINN, SHERRY L (OD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:L
Last Name:WINN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 W GROVE ST
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2090
Mailing Address - Country:US
Mailing Address - Phone:570-586-3228
Mailing Address - Fax:570-586-3524
Practice Address - Street 1:301 W GROVE ST
Practice Address - Street 2:SUITE 1-C
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2090
Practice Address - Country:US
Practice Address - Phone:570-586-3228
Practice Address - Fax:570-586-3524
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-25
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU84843Medicare UPIN
PA047539Medicare PIN