Provider Demographics
NPI:1851494769
Name:SHARMA, VISHAL (MD)
Entity Type:Individual
Prefix:
First Name:VISHAL
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12657 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:NY
Mailing Address - Zip Code:14081-9707
Mailing Address - Country:US
Mailing Address - Phone:716-934-3300
Mailing Address - Fax:716-934-3323
Practice Address - Street 1:12657 SENECA RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9707
Practice Address - Country:US
Practice Address - Phone:716-934-3300
Practice Address - Fax:716-934-3323
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002393207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000528897002OtherBC/BS
NY02677585Medicaid
NY0812965OtherIHA
NY00027283003OtherUNIVERA
P00249286OtherRAILROAD MEDICARE
P00249286OtherRAILROAD MEDICARE
I39708Medicare UPIN