Provider Demographics
NPI:1992774848
Name:SHERIDAN OPTICAL INC
Entity type:Organization
Organization Name:SHERIDAN OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:E
Authorized Official - Last Name:GROSHART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-672-5516
Mailing Address - Street 1:23 E GRINNELL PLZ
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3930
Mailing Address - Country:US
Mailing Address - Phone:307-672-5516
Mailing Address - Fax:307-672-7777
Practice Address - Street 1:23 E GRINNELL PLZ
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3930
Practice Address - Country:US
Practice Address - Phone:307-672-5516
Practice Address - Fax:307-672-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY185T332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106581500Medicaid
WY0719600001Medicare NSC