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NPI Code Detail

MEDICARE: DR. HEIDI ANNE SHUFELT OD

MEDICARE: DR. HEIDI ANNE SHUFELT OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist2554WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447200456
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HEIDI ANNE SHUFELT OD
Provider Business Mailing Address
First Line : 4801 WASHINGTON AVE
Second Line :
City : RACINE
State : WI
Zip : 53406-4219
Country : US
Telephone Number : 262-637-3733
Fax Number : 262-637-0752
Provider Business Practice Location Address
First Line : 4801 WASHINGTON AVE
Second Line :
City : RACINE
State : WI
Zip : 53406-4219
Country : US
Telephone Number : 262-637-3733
Fax Number : 262-637-0752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 07/08/2007

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