MEDICARE: DR. JERRY L. SHUE

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	2174	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0176870001	OTHER	AR	D MERC

General Provider Information

NPI Number	:	1487735718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JERRY L. SHUE

Provider Business Mailing Address
First Line	:	PO BOX 2100
Second Line	:
City	:	N LITTLE ROCK
State	:	AR
Zip	:	72115-2100
Country	:	US
Telephone Number	:	501-753-3145
Fax Number	:	501-753-1806

Provider Business Practice Location Address
First Line	:	406 W PERSHING BLVD
Second Line	:
City	:	N LITTLE ROCK
State	:	AR
Zip	:	72114-2146
Country	:	US
Telephone Number	:	501-753-3145
Fax Number	:	501-753-1806

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JERRY LESTER SHUE
Credential	:	OD
Telephone Number	:	501-753-3145

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/22/2020

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Directions to “DR. JERRY L. SHUE ” Practice Location

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