Provider Demographics
NPI:1982678454
Name:SHERMETARO, CHARLES GERARD (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GERARD
Last Name:SHERMETARO
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 1:48873 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4405
Mailing Address - Country:US
Mailing Address - Phone:586-247-2121
Mailing Address - Fax:586-532-7480
Practice Address - Street 1:48873 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-4405
Practice Address - Country:US
Practice Address - Phone:586-247-2121
Practice Address - Fax:586-532-7480
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003001152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944672833Medicaid
MI944672833Medicaid
MI0N92570Medicare PIN
MIU20090Medicare UPIN
MI5430410001Medicare PIN