Provider Demographics
NPI:1457319774
Name:HIBBETT, SHERI J (OD)
Entity Type:Individual
Prefix:DR
First Name:SHERI
Middle Name:J
Last Name:HIBBETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SHERI
Other - Middle Name:J
Other - Last Name:BIETER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:8617 W POINT DOUGLAS RD S
Mailing Address - Street 2:SUITE #110
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4145
Mailing Address - Country:US
Mailing Address - Phone:651-769-1020
Mailing Address - Fax:651-769-1021
Practice Address - Street 1:8617 W POINT DOUGLAS RD S
Practice Address - Street 2:SUITE #110
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4145
Practice Address - Country:US
Practice Address - Phone:651-769-1020
Practice Address - Fax:651-769-1021
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist