Provider Demographics
NPI:1952549677
Name:DECKER, SHARON R (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:R
Last Name:DECKER
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5016
Mailing Address - Country:US
Mailing Address - Phone:914-723-5800
Mailing Address - Fax:914-723-0162
Practice Address - Street 1:747 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5016
Practice Address - Country:US
Practice Address - Phone:914-723-5800
Practice Address - Fax:914-723-0162
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4439156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY058568001Medicare PIN