Provider Demographics
NPI:1043200876
Name:SHUTE, STEVEN W (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:W
Last Name:SHUTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:W
Other - Last Name:SHUTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:7075 N SHARON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3329
Mailing Address - Country:US
Mailing Address - Phone:559-486-2000
Mailing Address - Fax:559-256-8595
Practice Address - Street 1:7075 N SHARON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3329
Practice Address - Country:US
Practice Address - Phone:559-486-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5777152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410010243OtherRAILROAD MEDICARE
CASD0057770Medicaid
SD0057770Medicare PIN
CAT10114Medicare UPIN
410010243OtherRAILROAD MEDICARE