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General NPI Number Information
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NPI Number | 1508196668
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Entity Type | Organization
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Legal Business Name | GARRY C. SHOEMAKER, O.D., P.C.
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 1608 PLEASURE HOUSE RD SUITE 106
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-4046
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Country | US
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Telephone | 757-460-9402
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Fax | 757-460-9462
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Provider Business Mailing Address
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Address Line | 1608 PLEASURE HOUSE RD SUITE 106
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-4046
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Country | US
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Telephone | 757-460-9402
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Fax | 757-460-9462
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OSVALDO DIAZ
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Credential | OD
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Telephone | 757-460-9402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618000704
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License Number State | VA
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