Provider Demographics
NPI:1689916272
Name:SHARROW, MARK PATRICK
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:PATRICK
Last Name:SHARROW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 STATE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9407
Mailing Address - Country:US
Mailing Address - Phone:315-788-6070
Mailing Address - Fax:315-788-1950
Practice Address - Street 1:1815 STATE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9407
Practice Address - Country:US
Practice Address - Phone:315-788-6070
Practice Address - Fax:315-788-1950
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5663156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician