Provider Demographics
NPI:1417042276
Name:GARCIA, MARIA LYN-SHOOP (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LYN-SHOOP
Last Name:GARCIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:LYN
Other - Last Name:SHOOP-DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:172 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1756
Mailing Address - Country:US
Mailing Address - Phone:269-268-5140
Mailing Address - Fax:517-278-2199
Practice Address - Street 1:800 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2055
Practice Address - Country:US
Practice Address - Phone:517-278-2809
Practice Address - Fax:517-278-2199
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003648152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944205383Medicaid
MIU35798Medicare UPIN
MI0N11140Medicare PIN
MI944205383Medicaid