Provider Demographics
NPI:1184674566
Name:SHOEMAKER, CHRISTOPHER W (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:SHOEMAKER
Suffix:
Gender:M
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:PO BOX 5407
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-0407
Mailing Address - Country:US
Mailing Address - Phone:330-518-4561
Mailing Address - Fax:888-631-1436
Practice Address - Street 1:6828 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4503
Practice Address - Country:US
Practice Address - Phone:330-629-9870
Practice Address - Fax:330-629-9791
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3497 / T1403152W00000X, 152WC0802X, 152WP0200X, 152WV0400X, 152WL0500X, 152WX0102X
OH3496 / T1403152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2280106Medicaid
OH0485293Medicare PIN
OHT47206Medicare UPIN
OH1064550001Medicare NSC
OH410033860Medicare PIN