MEDICARE: STEVEN W SHUTE O D INC

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	332H00000X	Eyewear Supplier	5777	CA

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	:	1649593021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN W SHUTE O D INC

Provider Business Mailing Address
First Line	:	305 POLLASKY AVE
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93612-1139
Country	:	US
Telephone Number	:	559-299-4257
Fax Number	:	559-299-7702

Provider Business Practice Location Address
First Line	:	305 POLLASKY AVE
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93612-1139
Country	:	US
Telephone Number	:	559-299-4257
Fax Number	:	559-299-7702

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN WILLIAM SHUTE
Credential	:	O.D.
Telephone Number	:	559-299-4257

Provider Enumeration Date	:	03/12/2010
Last Update Date	:	03/12/2010

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