Provider Demographics
NPI:1649593021
Name:STEVEN W SHUTE O D INC
Entity Type:Organization
Organization Name:STEVEN W SHUTE O D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SHUTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-299-4257
Mailing Address - Street 1:305 POLLASKY AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1139
Mailing Address - Country:US
Mailing Address - Phone:559-299-4257
Mailing Address - Fax:559-299-7702
Practice Address - Street 1:305 POLLASKY AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1139
Practice Address - Country:US
Practice Address - Phone:559-299-4257
Practice Address - Fax:559-299-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5777332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0057770Medicaid
CA0209850001Medicare NSC
CASD0057770Medicaid
CAT10114Medicare UPIN