Provider Demographics
NPI:1568414829
Name:SHEWMAKE, RACHEL (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:SHEWMAKE
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 1:1200 W DEYOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4437
Mailing Address - Country:US
Mailing Address - Phone:618-993-5686
Mailing Address - Fax:618-997-6250
Practice Address - Street 1:297 S SILVER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6309
Practice Address - Country:US
Practice Address - Phone:573-651-5200
Practice Address - Fax:573-651-3743
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
106598OtherANTHEM BLUE CROSS BLUE SHIELD
MO410039298OtherMEDICARE RAILROAD
IL046008418Medicaid
MO2996OtherEYEMED
MO0814870006OtherMEDICARE NSC NUMBER
MO0814870015OtherMEDICARE NSC NUMBER
MO313901407Medicaid
050266OtherHEALTH ALLIANCE
MO0814870013OtherMEDICARE NSC NUMBER
MO0814870015OtherMEDICARE NSC NUMBER
MO313901407Medicaid