Provider Demographics
NPI:1194830901
Name:SHOOK, YVONNE TRACY (OD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:TRACY
Last Name:SHOOK
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 1:1433 EMERYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4590
Mailing Address - Country:US
Mailing Address - Phone:704-553-2020
Mailing Address - Fax:704-553-2256
Practice Address - Street 1:1433 EMERYWOOD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4590
Practice Address - Country:US
Practice Address - Phone:704-553-2020
Practice Address - Fax:704-553-2256
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6817040OtherCIGNA
NC204193382OtherVISION SERVICE PLAN
NC0987AOtherBLUE CROSS BLUE SHIELD
NC204193382OtherUNITED HEALTHCARE
NC0987AOtherNC HEALTHCHOICE
NC28919OtherPARTNERS
NC890987AMedicaid