Provider Demographics
NPI:1629060751
Name:SHERMAN, MARC H (OD, PA)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:H
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 W STATE ROAD 434
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3847
Mailing Address - Country:US
Mailing Address - Phone:407-332-8255
Mailing Address - Fax:407-332-5769
Practice Address - Street 1:1495 W STATE ROAD 434
Practice Address - Street 2:SUITE 109
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-3847
Practice Address - Country:US
Practice Address - Phone:407-332-8255
Practice Address - Fax:407-332-5769
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1051152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084456000Medicaid
FLD04539OtherRAILROAD MEDICARE
FL084456000Medicaid
FLT84005Medicare UPIN