Provider Demographics
NPI:1194105403
Name:SHERRILL, FORREST LANDON (OD)
Entity type:Individual
Prefix:DR
First Name:FORREST
Middle Name:LANDON
Last Name:SHERRILL
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 1:524 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3427
Mailing Address - Country:US
Mailing Address - Phone:901-356-2032
Mailing Address - Fax:
Practice Address - Street 1:373 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6741
Practice Address - Country:US
Practice Address - Phone:865-224-6434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3224152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist