Provider Demographics
NPI:1659454916
Name:SHEARER, CHARLES E (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:SHEARER
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 1:517 LINCOLNWAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2211
Mailing Address - Country:US
Mailing Address - Phone:574-255-6363
Mailing Address - Fax:574-255-4182
Practice Address - Street 1:517 LINCOLNWAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2211
Practice Address - Country:US
Practice Address - Phone:574-255-6363
Practice Address - Fax:574-255-4182
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084194OtherBLUE CROSS BLUE SHIELD
IN1659454916OtherNPI
IN100222260AMedicaid
IN0480240001Medicare NSC
IN736610Medicare PIN
IN000000084194OtherBLUE CROSS BLUE SHIELD