Provider Demographics
NPI:1609191402
Name:SHARON L YURKO O D INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SHARON L YURKO O D INC A PROFESSIONAL CORPORATION
Other - Org Name:EYEOPTICS OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:YURKO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-684-6688
Mailing Address - Street 1:8246 LAGUNA BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7968
Mailing Address - Country:US
Mailing Address - Phone:916-684-6688
Mailing Address - Fax:916-684-6721
Practice Address - Street 1:8246 LAGUNA BLVD
Practice Address - Street 2:STE 300
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7968
Practice Address - Country:US
Practice Address - Phone:916-684-6688
Practice Address - Fax:916-684-6721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8359T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEO089AMedicare PIN