Healthcare Provider Details

I. General information

NPI: 1184674566
Provider Name (Legal Business Name): CHRISTOPHER W SHOEMAKER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6828 MARKET ST
BOARDMAN OH
44512-4503
US

IV. Provider business mailing address

PO BOX 5407
POLAND OH
44514-0407
US

V. Phone/Fax

Practice location:
  • Phone: 330-629-9870
  • Fax: 330-629-9791
Mailing address:
  • Phone: 330-518-4561
  • Fax: 888-631-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3497 / T1403
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3497 / T1403
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number3497 / T1403
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number3496 / T1403
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number3497 / T1403
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number3497 / T1403
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number3497 / T1403
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: