Provider Demographics
NPI:1386741296
Name:SHERIDAN, PETER J (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1290
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1290
Mailing Address - Country:US
Mailing Address - Phone:434-385-5600
Mailing Address - Fax:434-455-7172
Practice Address - Street 1:356 FRONT ST
Practice Address - Street 2:
Practice Address - City:LOVINGSTON
Practice Address - State:VA
Practice Address - Zip Code:22949-2360
Practice Address - Country:US
Practice Address - Phone:434-385-5600
Practice Address - Fax:434-455-7172
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U55369Medicare UPIN