Provider Demographics
NPI:1598747586
Name:SHARP, JILL M (OD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:SHARP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:RENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:27 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6221
Mailing Address - Country:US
Mailing Address - Phone:716-483-2020
Mailing Address - Fax:716-488-9295
Practice Address - Street 1:27 PORTER AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6221
Practice Address - Country:US
Practice Address - Phone:716-483-2020
Practice Address - Fax:716-488-9295
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG00301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001657600Medicaid
NY01770621Medicaid
PA0399350004Medicare NSC
NY0399350003Medicare NSC
PA066740E41Medicare PIN
NY01770621Medicaid