Healthcare Provider Details

I. General information

NPI: 1356979801
Provider Name (Legal Business Name): AUMER SHUGHOURY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CEI DR
BLUE ASH OH
45242-5664
US

IV. Provider business mailing address

15933 CLAYTON RD STE 210
BALLWIN MO
63011-2172
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-5133
  • Fax:
Mailing address:
  • Phone: 636-227-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.170368
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number60436
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number036.170368
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.152737
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: