Provider Demographics
NPI:1588858062
Name:DEANER-HARRINGTON, SHERRY DENISE (OD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:DENISE
Last Name:DEANER-HARRINGTON
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 1:681 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5703
Mailing Address - Country:US
Mailing Address - Phone:619-420-2111
Mailing Address - Fax:619-585-8130
Practice Address - Street 1:480 4TH AVE STE 412
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4413
Practice Address - Country:US
Practice Address - Phone:619-422-1471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10628TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0106280Medicaid
CASD0106280Medicaid
CAWOP10628BMedicare UPIN