Provider Demographics
NPI:1801830039
Name:JICK, SHARON (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:JICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9890 CLAYTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1685
Mailing Address - Country:US
Mailing Address - Phone:314-395-9613
Mailing Address - Fax:314-395-9621
Practice Address - Street 1:9890 CLAYTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1685
Practice Address - Country:US
Practice Address - Phone:314-395-9613
Practice Address - Fax:314-395-9621
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2019-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2003015681207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH89427Medicare UPIN