Provider Demographics
NPI:1508196668
Name:GARRY C. SHOEMAKER, O.D., P.C.
Entity Type:Organization
Organization Name:GARRY C. SHOEMAKER, O.D., P.C.
Other - Org Name:SHOEMAKER VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-460-9402
Mailing Address - Street 1:1608 PLEASURE HOUSE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4046
Mailing Address - Country:US
Mailing Address - Phone:757-460-9402
Mailing Address - Fax:757-460-9462
Practice Address - Street 1:1608 PLEASURE HOUSE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-4046
Practice Address - Country:US
Practice Address - Phone:757-460-9402
Practice Address - Fax:757-460-9462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000704152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5464802OtherAETNA
VA33036OtherOPTIMA
VA394271OtherANTHEM BLUE CROSS BLUE SHIELD
VADQ0280OtherRAILROAD MEDICARE
VA009233849Medicaid
VA5464802OtherAETNA
VA394271OtherANTHEM BLUE CROSS BLUE SHIELD