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Individual

MRS. SHERRY LYNNE SHEPHERD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
102 SANTA FE AVE, LA JUNTA, CO 81050-1523
(719) 384-8719
(719) 384-8738
Mailing address
27 MONTEBELLO RD, PUEBLO, CO 81001-1236
(719) 545-1530
(719) 545-2899

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2337
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
73921050
CO
01
P00476844
RAILROAD MEDICARE
CO
Enumeration date
12/26/2006
Last updated
12/06/2012
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