MEDICARE: YVONNE T. SHOOK O.D.P.A.

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	NC1355	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336415579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YVONNE T. SHOOK O.D.P.A.

Provider Business Mailing Address
First Line	:	1433 EMERYWOOD DR
Second Line	:	SUITE C
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-4105
Country	:	US
Telephone Number	:	704-553-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 EMERYWOOD DR
Second Line	:	SUITE C
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-4105
Country	:	US
Telephone Number	:	704-553-2020
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. YVONNE T SHOOK
Credential	:	O.D.
Telephone Number	:	704-553-2020

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	03/30/2012

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