Provider Demographics
NPI:1609056340
Name:SHERMAN, NICOLE P (OD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:P
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7367 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7619
Mailing Address - Country:US
Mailing Address - Phone:803-788-1335
Mailing Address - Fax:
Practice Address - Street 1:7367 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7619
Practice Address - Country:US
Practice Address - Phone:803-788-1335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1486152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDO2039OtherRR MEDICARE GP PTAN
SCDO2039OtherRR MEDICARE GP PTAN