Provider Demographics
NPI:1073514204
Name:SHEARER, THEA T (OD)
Entity Type:Individual
Prefix:DR
First Name:THEA
Middle Name:T
Last Name:SHEARER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 ATWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8898
Mailing Address - Country:US
Mailing Address - Phone:859-624-2015
Mailing Address - Fax:859-624-4415
Practice Address - Street 1:5019 ATWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8898
Practice Address - Country:US
Practice Address - Phone:859-624-2015
Practice Address - Fax:859-624-4415
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1478DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000388Medicaid
KY000000195501OtherANTHEM
KYOP0933OtherEYE MED
KY77000388Medicaid
U76354Medicare UPIN
KYP00879787Medicare PIN