Provider Demographics
NPI:1710991872
Name:SHUM, STEVEN R (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:SHUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2109 WEST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3837
Mailing Address - Country:US
Mailing Address - Phone:901-754-6020
Mailing Address - Fax:901-754-9882
Practice Address - Street 1:2109 WEST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3837
Practice Address - Country:US
Practice Address - Phone:901-754-6020
Practice Address - Fax:901-754-9882
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN547152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2240152OtherUHC
TN0159021OtherBCBS OF TN PROVIDER ID
TN410010020OtherMEDICARE RR
TN6172558OtherCIGNA
TN410010020OtherMEDICARE RR
TN0626860001Medicare NSC