Healthcare Provider Details

I. General information

NPI: 1649593021
Provider Name (Legal Business Name): STEVEN W SHUTE O D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 POLLASKY AVE
CLOVIS CA
93612-1139
US

IV. Provider business mailing address

305 POLLASKY AVE
CLOVIS CA
93612-1139
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-4257
  • Fax: 559-299-7702
Mailing address:
  • Phone: 559-299-4257
  • Fax: 559-299-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number5777
License Number StateCA

VIII. Authorized Official

Name: DR. STEVEN WILLIAM SHUTE
Title or Position: PRESIDENT
Credential: O.D.
Phone: 559-299-4257