Provider Demographics
NPI:1578595922
Name:SHOEMAKER, GARRY CARLTON (OD)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:CARLTON
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 1:1608 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
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000704152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009233849Medicaid
VA394271OtherANTHEM BC/ BS
VA5464802OtherAETNA
VA410039168OtherRAILROAD MEDICARE
VA5140690001Medicare NSC
VA410039168OtherRAILROAD MEDICARE