MEDICARE: DR SHEWMAKER & ASSOCIATES OPTOMETRISTS INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1753DT	KY
2	156FX1800X	Optician	KY1377	KY
3	152W00000X	Optometrist	1653DT	KY
4	152W00000X	Optometrist	1569DT	KY
5	152W00000X	Optometrist	1570DT	KY
6	152W00000X	Optometrist	0938DT	KY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	45003993	OTHER	KY	EPSDT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1871641332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR SHEWMAKER & ASSOCIATES OPTOMETRISTS INC

Provider Business Mailing Address
First Line	:	2174 DIXIE HWY
Second Line	:
City	:	FORT MITCHELL
State	:	KY
Zip	:	41017-2902
Country	:	US
Telephone Number	:	859-341-2566
Fax Number	:	859-341-2568

Provider Business Practice Location Address
First Line	:	2174 DIXIE HWY
Second Line	:
City	:	FORT MITCHELL
State	:	KY
Zip	:	41017-2902
Country	:	US
Telephone Number	:	859-341-2566
Fax Number	:	859-341-2568

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	VIRGINIA LACHMANN
Credential	:
Telephone Number	:	859-341-2566

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	01/04/2019

2174 DIXIE HWY
FORT MITCHELL, KY
41017-2902

Practice Phone: 859-341-2566
Practice Fax: 859-341-2568