Provider Demographics
NPI:1710037445
Name:MCDONALD, SHAWN MITCHELL (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MITCHELL
Last Name:MCDONALD
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 1:2802 MALLARD LANE
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667
Mailing Address - Country:US
Mailing Address - Phone:530-626-8440
Mailing Address - Fax:530-626-1897
Practice Address - Street 1:2802 MALLARD LANE
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667
Practice Address - Country:US
Practice Address - Phone:530-626-8440
Practice Address - Fax:530-626-1897
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4912690001Medicare NSC
CAU17405Medicare UPIN
CASD0085430Medicare Oscar/Certification
CASD0085430Medicare PIN