Provider Demographics
NPI:1730132614
Name:SHUTE, DONALD T (OPTOMETRIC DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:T
Last Name:SHUTE
Suffix:
Gender:M
Credentials:OPTOMETRIC DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3961
Mailing Address - Country:US
Mailing Address - Phone:509-966-2966
Mailing Address - Fax:509-966-3230
Practice Address - Street 1:1211 S 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3961
Practice Address - Country:US
Practice Address - Phone:509-966-2966
Practice Address - Fax:509-966-3230
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001620152W00000X
OR1730D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASH2222OtherREGENCE BLUE SHIELD
WA2001345Medicaid
WA1730132614Medicare Oscar/Certification
WASH2222OtherREGENCE BLUE SHIELD
WA1295860001Medicare NSC
WA1730132614Medicare NSC
WA1730132614Medicare PIN