MEDICARE: GARRY C. SHOEMAKER, O.D., P.C.

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	0618000704	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DQ0280	OTHER	VA	RAILROAD MEDICARE

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
2	33036	OTHER	VA	OPTIMA
4	394271	OTHER	VA	ANTHEM BLUE CROSS BLUE SHIELD
5	5464802	OTHER	VA	AETNA

General Provider Information

NPI Number	:	1508196668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARRY C. SHOEMAKER, O.D., P.C.

Provider Business Mailing Address
First Line	:	1608 PLEASURE HOUSE RD
Second Line	:	SUITE 106
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4046
Country	:	US
Telephone Number	:	757-460-9402
Fax Number	:	757-460-9462

Provider Business Practice Location Address
First Line	:	1608 PLEASURE HOUSE RD
Second Line	:	SUITE 106
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-4046
Country	:	US
Telephone Number	:	757-460-9402
Fax Number	:	757-460-9462

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OSVALDO DIAZ
Credential	:	OD
Telephone Number	:	757-460-9402

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	04/30/2024

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