Provider Demographics
NPI:1104025089
Name:KING, SHERALYN KYLE (OD)
Entity type:Individual
Prefix:DR
First Name:SHERALYN
Middle Name:KYLE
Last Name:KING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SHERALYN
Other - Middle Name:KYLE
Other - Last Name:CERUTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:19336 LEITERSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1436
Mailing Address - Country:US
Mailing Address - Phone:717-263-7050
Mailing Address - Fax:717-263-3277
Practice Address - Street 1:1800 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-1879
Practice Address - Country:US
Practice Address - Phone:717-762-9178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019527740003Medicaid
PA1019527740003Medicaid