Healthcare Provider Details

I. General information

NPI: 1881797108
Provider Name (Legal Business Name): STEVE R. SHOOK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 W 29TH ST S
WICHITA KS
67217-3114
US

IV. Provider business mailing address

1014 W 29TH ST S
WICHITA KS
67217-3114
US

V. Phone/Fax

Practice location:
  • Phone: 316-613-2033
  • Fax: 316-613-2237
Mailing address:
  • Phone: 316-613-2033
  • Fax: 316-613-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1076-3
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: