MEDICARE: DR. THOMASON J SHIREY 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	2758	TX

General Provider Information

NPI Number	:	1740287234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMASON J SHIREY O.D.

Provider Business Mailing Address
First Line	:	1401 S CHERRY LN
Second Line	:	SUITE A
City	:	FORT WORTH
State	:	TX
Zip	:	76108-3672
Country	:	US
Telephone Number	:	817-246-3177
Fax Number	:	817-246-3277

Provider Business Practice Location Address
First Line	:	1401 S CHERRY LN
Second Line	:	SUITE A
City	:	FORT WORTH
State	:	TX
Zip	:	76108-3672
Country	:	US
Telephone Number	:	817-246-3177
Fax Number	:	817-246-3277

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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