Provider Demographics
NPI:1174216972
Name:SHERWOOD, WESTON EDWARD (OD)
Entity type:Individual
Prefix:
First Name:WESTON
Middle Name:EDWARD
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 E JEWELL AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4606
Mailing Address - Country:US
Mailing Address - Phone:303-332-8244
Mailing Address - Fax:
Practice Address - Street 1:1399 S HAVANA ST STE 101
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4041
Practice Address - Country:US
Practice Address - Phone:303-750-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
COOPT.0003929152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program