Provider Demographics
NPI:1245357003
Name:STANICH, SHARON (OD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:STANICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:STANICH
Other - Last Name:CHIRUMBOLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:660 RED ROCK DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-2284
Mailing Address - Country:US
Mailing Address - Phone:330-336-3732
Mailing Address - Fax:
Practice Address - Street 1:796 HOWE AVE
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-5124
Practice Address - Country:US
Practice Address - Phone:330-922-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist