Provider Demographics
NPI:1962575225
Name:SHERMAN, KEITH T (OD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:T
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 1:15 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-1148
Mailing Address - Country:US
Mailing Address - Phone:606-564-3650
Mailing Address - Fax:606-564-3651
Practice Address - Street 1:15 E 3RD ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-1148
Practice Address - Country:US
Practice Address - Phone:606-564-3650
Practice Address - Fax:606-564-3651
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY822DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77008225Medicaid
KY77008225Medicaid
KY0002302Medicare ID - Type Unspecified