Provider Demographics
NPI:1629170378
Name:WOLFF, SHARON (OD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:WOLFF
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 1:4000 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2968
Mailing Address - Country:US
Mailing Address - Phone:763-788-9147
Mailing Address - Fax:763-782-8154
Practice Address - Street 1:4000 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2968
Practice Address - Country:US
Practice Address - Phone:763-788-9147
Practice Address - Fax:763-782-8154
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN2609152W00000X
ND556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNWO1513347OtherCLARITY VISION
MNMN2609OtherEYEMED
MN2201084OtherMEDICA/UNITED HEALTH CARE
MN183M6WOOtherBCBS/MN
MN2219196OtherAMERICA'S PPO
MN842324500Medicaid
MN2201084OtherMEDICA/UNITED HEALTH CARE
MNMN2609OtherEYEMED