Provider Demographics
NPI:1871538512
Name:HEATH, SHERI ANN (OD)
Entity type:Individual
Prefix:DR
First Name:SHERI
Middle Name:ANN
Last Name:HEATH
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 1:631 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2817
Mailing Address - Country:US
Mailing Address - Phone:510-207-1826
Mailing Address - Fax:
Practice Address - Street 1:4041 E CASTRO VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-4840
Practice Address - Country:US
Practice Address - Phone:510-881-8343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11646T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU87776Medicare UPIN
CA0262880002Medicare NSC