MEDICARE: MICHAEL SHURLEY 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	TO2772	MO
2	152WC0802X	Corneal and Contact Management Optometrist	TO2772	MO
3	152WP0200X	Pediatric Optometrist	TO2772	MO
4	152WX0102X	Occupational Vision Optometrist	TO2772	MO

General Provider Information

NPI Number	:	1366436370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SHURLEY O.D.

Provider Business Mailing Address
First Line	:	426 W COLER ST
Second Line	:
City	:	NEOSHO
State	:	MO
Zip	:	64850-1441
Country	:	US
Telephone Number	:	417-451-2378
Fax Number	:	417-451-4484

Provider Business Practice Location Address
First Line	:	426 W COLER ST
Second Line	:
City	:	NEOSHO
State	:	MO
Zip	:	64850-1441
Country	:	US
Telephone Number	:	417-451-2378
Fax Number	:	417-451-4484

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	11/29/2007

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