Provider Demographics
NPI:1134186448
Name:SHERRILL, DONNA D (OD)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:D
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:D
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:11808-1 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-262-2249
Mailing Address - Fax:904-268-8283
Practice Address - Street 1:11808-1 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-262-2249
Practice Address - Fax:904-268-8283
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20351OtherBCBS
FL20351OtherBCBS
FLU33262Medicare UPIN
FL20351ZMedicare PIN