Provider Demographics
NPI:1962620757
Name:SHARPTON, WM C JR (OD)
Entity type:Individual
Prefix:DR
First Name:WM
Middle Name:C
Last Name:SHARPTON
Suffix:JR
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 1:604 LAKE RABUN ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKEMONT
Mailing Address - State:GA
Mailing Address - Zip Code:30552
Mailing Address - Country:US
Mailing Address - Phone:706-782-9923
Mailing Address - Fax:
Practice Address - Street 1:604 LAKE RABUN ROAD
Practice Address - Street 2:
Practice Address - City:LAKEMONT
Practice Address - State:GA
Practice Address - Zip Code:30552
Practice Address - Country:US
Practice Address - Phone:706-782-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT658152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
060645OtherARBO