Provider Demographics
NPI:1669929501
Name:SHERMAN, JUSTIN (OD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:SHERMAN
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 1:303 HORSHAM RD STE G
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2029
Mailing Address - Country:US
Mailing Address - Phone:267-965-2599
Mailing Address - Fax:267-965-2598
Practice Address - Street 1:1930 S BROAD ST UNIT 9
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2328
Practice Address - Country:US
Practice Address - Phone:800-448-6767
Practice Address - Fax:215-339-8103
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13887901OtherCAQH NUMBER