MEDICARE: DR. CHRISTOPHER E. SHEWAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4682/ T1457	OH

General Provider Information

NPI Number	:	1073570537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER E. SHEWAN O.D.

Provider Business Mailing Address
First Line	:	35 PLYMOUTH ST
Second Line	:
City	:	LEXINGTON
State	:	OH
Zip	:	44904-1123
Country	:	US
Telephone Number	:	419-884-0500
Fax Number	:	419-884-1113

Provider Business Practice Location Address
First Line	:	35 PLYMOUTH ST
Second Line	:
City	:	LEXINGTON
State	:	OH
Zip	:	44904
Country	:	US
Telephone Number	:	419-884-0500
Fax Number	:	419-884-1113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	04/28/2020

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