Provider Demographics
NPI:1659401560
Name:SHARON, DAVID E (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:SHARON
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E CLEMENTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-1455
Mailing Address - Country:US
Mailing Address - Phone:856-939-5515
Mailing Address - Fax:856-939-5541
Practice Address - Street 1:700 E CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-1455
Practice Address - Country:US
Practice Address - Phone:856-939-5515
Practice Address - Fax:856-939-5541
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD-988156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ067-871-0001Medicare ID - Type Unspecified