Provider Demographics
NPI:1710220280
Name:SHARER, ERIC CHRISTOPHER (MPH, RD, LDN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:CHRISTOPHER
Last Name:SHARER
Suffix:
Gender:M
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 OLD ORCHARD RD
Mailing Address - Street 2:C/O BLOCK CENTER FOR INTEGRATIVE CA
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1034
Mailing Address - Country:US
Mailing Address - Phone:847-492-3040
Mailing Address - Fax:847-505-0822
Practice Address - Street 1:5230 OLD ORCHARD RD
Practice Address - Street 2:C/O BLOCK CENTER FOR INTEGRATIVE CA
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1034
Practice Address - Country:US
Practice Address - Phone:847-492-3040
Practice Address - Fax:847-505-0822
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005300133N00000X, 133NN1002X, 133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19542OtherMEDICARE GROUP #
IL212041OtherMEDICARE GROUP #