MEDICARE: DR. JOHN EDWARD SHEARY OD

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	18002299B	IN
2	152W00000X	Optometrist	OD001172	TN

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

General Provider Information

NPI Number	:	1568444917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN EDWARD SHEARY OD

Provider Business Mailing Address
First Line	:	7720 N CRESTLINE DR
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-1907
Country	:	US
Telephone Number	:	309-693-9540
Fax Number	:

Provider Business Practice Location Address
First Line	:	288 N PARK ST
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62523-1306
Country	:	US
Telephone Number	:	217-422-3881
Fax Number	:

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	06/23/2010

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