Healthcare Provider Details

I. General information

NPI: 1801949227
Provider Name (Legal Business Name): DR SHEWMAKER & ASSOCIATES OPTOMETRISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 FASHION RIDGE RD
DRY RIDGE KY
41035-9609
US

IV. Provider business mailing address

1114 FASHION RIDGE RD
DRY RIDGE KY
41035-9609
US

V. Phone/Fax

Practice location:
  • Phone: 859-824-4415
  • Fax: 859-824-4497
Mailing address:
  • Phone: 859-824-4415
  • Fax: 859-824-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1570DT
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1653DT
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1569DT
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1753DT
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberKY-1377
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0938DT
License Number StateKY

VIII. Authorized Official

Name: VIRGINIA LACHMANN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 859-341-2566