Provider Demographics
NPI:1871641332
Name:DR SHEWMAKER & ASSOCIATES OPTOMETRISTS INC
Entity Type:Organization
Organization Name:DR SHEWMAKER & ASSOCIATES OPTOMETRISTS INC
Other - Org Name:VISION ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-341-2566
Mailing Address - Street 1:2174 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2902
Mailing Address - Country:US
Mailing Address - Phone:859-341-2566
Mailing Address - Fax:859-341-2568
Practice Address - Street 1:2174 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FORT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-2902
Practice Address - Country:US
Practice Address - Phone:859-341-2566
Practice Address - Fax:859-341-2568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0938DT152W00000X
KY1569DT152W00000X
KY1570DT152W00000X
KY1653DT152W00000X
KY1753DT152W00000X
KYKY1377156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100057440Medicaid
KY77001030Medicaid
KY45003993OtherEPSDT
KY77000974Medicaid
KY77009389Medicaid
KY7100172260Medicaid
KY77001659Medicaid
KYU98063Medicare UPIN
KY9334401Medicare ID - Type UnspecifiedLYNN SHEWMAKER
KY7100057440Medicaid
KY45003993OtherEPSDT
KYT54668Medicare UPIN
KY77001659Medicaid
KY77000974Medicaid
KY7100172260Medicaid