MEDICARE: DR. RACHEL SHEWMAKE 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	T02996	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410039298	OTHER	MO	MEDICARE RAILROAD
5	0814870006	OTHER	MO	MEDICARE NSC NUMBER
6	0814870015	OTHER	MO	MEDICARE NSC NUMBER
9	0814870013	OTHER	MO	MEDICARE NSC NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	106598	OTHER	ANTHEM BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MO2996	OTHER	EYEMED
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	050266	OTHER	HEALTH ALLIANCE

General Provider Information

NPI Number	:	1568414829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL SHEWMAKE O.D.

Provider Business Mailing Address
First Line	:	1200 W DEYOUNG ST
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-4437
Country	:	US
Telephone Number	:	618-993-5686
Fax Number	:	618-997-6250

Provider Business Practice Location Address
First Line	:	297 S SILVER SPRINGS RD
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-6309
Country	:	US
Telephone Number	:	573-651-5200
Fax Number	:	573-651-3743

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	10/06/2008

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