Provider Demographics
NPI:1336218007
Name:SHERMULIS, JOHN A (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:SHERMULIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:9439 DUNMURRY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1139
Mailing Address - Country:US
Mailing Address - Phone:708-361-2201
Mailing Address - Fax:773-445-4265
Practice Address - Street 1:10719 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3135
Practice Address - Country:US
Practice Address - Phone:773-445-4200
Practice Address - Fax:773-445-4265
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T38773Medicare UPIN
766210Medicare ID - Type Unspecified