Provider Demographics
NPI:1699405332
Name:SERINO, SHARON (LDO)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SERINO
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5004
Mailing Address - Country:US
Mailing Address - Phone:864-288-2813
Mailing Address - Fax:864-288-2820
Practice Address - Street 1:3925 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5004
Practice Address - Country:US
Practice Address - Phone:864-288-2813
Practice Address - Fax:864-288-2820
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC846156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician