Basic Information
| Provider Information | |||||||||
| NPI: | 1326323445 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRISON | ||||||||
| FirstName: | SHERELLE | ||||||||
| MiddleName: | MCCOY | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 OLD GALLOWS RD STE 520 | ||||||||
| Address2: | |||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823970 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6300 E INDEPENDENCE BLVD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045350925 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2011 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2224 | SC | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OEG002568 | PA | N | Eye and Vision Services Providers | Optometrist | 152WV0400X | 2293 | NC | N | Eye and Vision Services Providers | Optometrist | Vision Therapy | 152W00000X | 2293 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 12254632 | 01 | PA | CAQH PROVIDER ID | OTHER |