Provider Demographics
NPI:1598812075
Name:MOORE, SHERL CHRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHERL
Middle Name:CHRISTINE
Last Name:MOORE
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 1:415 N WILSON ST
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-2432
Mailing Address - Country:US
Mailing Address - Phone:918-256-5646
Mailing Address - Fax:918-256-7727
Practice Address - Street 1:415 N WILSON ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-2432
Practice Address - Country:US
Practice Address - Phone:918-256-5646
Practice Address - Fax:918-456-0020
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist