Provider Demographics
NPI:1457325565
Name:SHERIDAN, DONISE B (OD)
Entity Type:Individual
Prefix:DR
First Name:DONISE
Middle Name:B
Last Name:SHERIDAN
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 1:1400 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066
Mailing Address - Country:US
Mailing Address - Phone:270-247-2417
Mailing Address - Fax:270-247-2090
Practice Address - Street 1:1400 COMMONWEALTH DR.
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066
Practice Address - Country:US
Practice Address - Phone:270-247-2417
Practice Address - Fax:270-247-2090
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1388DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY135441OtherCOLE MANAGED VISION
KY390980OtherHEALTHLINK
KY5679620OtherAETNA
KY77013886Medicaid
KYU68612OtherBLUEGRASS FAMILY HEALTH
KY000000214672OtherBLUE CROSS BLUE SHIELD
KY000000214672OtherBLUE CROSS BLUE SHIELD
KYP00030873Medicare PIN
KY135441OtherCOLE MANAGED VISION
KYMS0289137OtherDEA
KY77013886Medicaid