=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801949227
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR SHEWMAKER & ASSOCIATES OPTOMETRISTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 01/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1114 FASHION RIDGE RD
-----------------------------------------------------
City | DRY RIDGE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41035-9609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-824-4415
-----------------------------------------------------
Fax | 859-824-4497
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1114 FASHION RIDGE RD
-----------------------------------------------------
City | DRY RIDGE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41035-9609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-824-4415
-----------------------------------------------------
Fax | 859-824-4497
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | VIRGINIA LACHMANN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-341-2566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1570DT
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1653DT
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1569DT
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1753DT
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | KY-1377
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 0938DT
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------