Provider Demographics
NPI:1467548313
Name:SHERIFF, TOM (OD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:SHERIFF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:SHEIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4206 KEMP BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2845
Mailing Address - Country:US
Mailing Address - Phone:940-696-2653
Mailing Address - Fax:940-696-2685
Practice Address - Street 1:4206 KEMP BLVD
Practice Address - Street 2:STE B
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2845
Practice Address - Country:US
Practice Address - Phone:940-696-2653
Practice Address - Fax:940-696-2685
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3216TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093168501Medicaid
TX093168501Medicaid
T157876Medicare UPIN