Provider Demographics
NPI:1104947720
Name:SHERBAN, RAYMOND JOSEPH (OD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOSEPH
Last Name:SHERBAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 NORTH PASEO ARENAL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1474
Mailing Address - Country:US
Mailing Address - Phone:520-573-0219
Mailing Address - Fax:520-294-2686
Practice Address - Street 1:1650 WEST VALENCIA ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746
Practice Address - Country:US
Practice Address - Phone:520-573-0219
Practice Address - Fax:520-294-2686
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist