MEDICARE: SHANE CHARLES STEWART 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	4901004615	MI

General Provider Information

NPI Number	:	1386947802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE CHARLES STEWART O.D.

Provider Business Mailing Address
First Line	:	5210 TWINGING DR
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-2977
Country	:	US
Telephone Number	:	231-878-1445
Fax Number	:

Provider Business Practice Location Address
First Line	:	533 N MARKETPLACE BLVD
Second Line	:	STE. 6
City	:	LANSING
State	:	MI
Zip	:	48917-7735
Country	:	US
Telephone Number	:	517-627-5403
Fax Number	:

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

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	07/03/2014

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Directions to “ SHANE CHARLES STEWART O.D.” Practice Location

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