Provider Demographics
NPI:1932281144
Name:SHADWICK, STEVEN ALEXANDER (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALEXANDER
Last Name:SHADWICK
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 1:1053 SUMMITT DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3464
Mailing Address - Country:US
Mailing Address - Phone:513-422-8031
Mailing Address - Fax:513-422-8624
Practice Address - Street 1:1053 SUMMITT DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3464
Practice Address - Country:US
Practice Address - Phone:513-422-8031
Practice Address - Fax:513-422-8624
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3753 T645152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0581562Medicaid
OHSHO560952Medicare ID - Type Unspecified
OH0581562Medicaid