Provider Demographics
NPI:1730171422
Name:SHER, JONATHAN D (PC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:SHER
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 VIRGINIA PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5082
Mailing Address - Country:US
Mailing Address - Phone:972-542-2269
Mailing Address - Fax:972-548-8802
Practice Address - Street 1:2770 VIRGINIA PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5082
Practice Address - Country:US
Practice Address - Phone:972-542-2269
Practice Address - Fax:972-548-8802
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4145TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0934838Medicaid
00E56QMedicare PIN
TX5321310001Medicare NSC
TXT95842Medicare UPIN