Basic Information
| Provider Information | |||||||||
| NPI: | 1861165417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENLY | ||||||||
| FirstName: | SHERYL | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CVS DRIVE | ||||||||
| Address2: | MAIL STOP #3005 | ||||||||
| City: | WOONSOCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017702286 | ||||||||
| FaxNumber: | 4012694731 | ||||||||
| Practice Location | |||||||||
| Address1: | 8831 VILLA LA JOLLA DR | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8588884791 | ||||||||
| FaxNumber: | 8584576990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2021 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 41966 | CA | Y | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.