Provider Demographics
NPI:1699801324
Name:SHERMAN, GLENN (OD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:SHERMAN
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 1:856 US HIGHWAY 206
Mailing Address - Street 2:MOUNTAINVIEW PLAZA
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1514
Mailing Address - Country:US
Mailing Address - Phone:908-359-4363
Mailing Address - Fax:908-359-6509
Practice Address - Street 1:856 US HIGHWAY 206
Practice Address - Street 2:MOUNTAINVIEW PLAZA
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1514
Practice Address - Country:US
Practice Address - Phone:908-359-4363
Practice Address - Fax:908-359-6509
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU02015Medicare UPIN
NJ618-932Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER