Provider Demographics
NPI:1629144340
Name:SHULMAN, MARK M (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:SHULMAN
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 1:1202B WOODWARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661
Mailing Address - Country:US
Mailing Address - Phone:256-381-0100
Mailing Address - Fax:256-381-4958
Practice Address - Street 1:1202B WOODWARD AVENUE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661
Practice Address - Country:US
Practice Address - Phone:256-381-0100
Practice Address - Fax:256-381-4958
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS423 TA358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U56231Medicare UPIN
ALU56231Medicare UPIN
000058641Medicare ID - Type Unspecified