Healthcare Provider Details

I. General information

NPI: 1508196668
Provider Name (Legal Business Name): GARRY C. SHOEMAKER, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 PLEASURE HOUSE RD SUITE 106
VIRGINIA BEACH VA
23455-4046
US

IV. Provider business mailing address

1608 PLEASURE HOUSE RD SUITE 106
VIRGINIA BEACH VA
23455-4046
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-9402
  • Fax: 757-460-9462
Mailing address:
  • Phone: 757-460-9402
  • Fax: 757-460-9462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000704
License Number StateVA

VIII. Authorized Official

Name: DR. OSVALDO DIAZ
Title or Position: PRESIDENT
Credential: OD
Phone: 757-460-9402