Provider Demographics
NPI:1942517743
Name:STEWART SHOFNER MD PC
Entity Type:Organization
Organization Name:STEWART SHOFNER MD PC
Other - Org Name:SHOFNER VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITESIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-340-4733
Mailing Address - Street 1:2021 CHURCH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2021
Mailing Address - Country:US
Mailing Address - Phone:615-340-4733
Mailing Address - Fax:615-340-4734
Practice Address - Street 1:2021 CHURCH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2021
Practice Address - Country:US
Practice Address - Phone:615-340-4733
Practice Address - Fax:615-340-4734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20369207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN01055839OtherAMERIGROUP
TN4402408OtherAETNA
TNP00116360OtherRAILROAD MEDICARE
TN0102059OtherBCBST
TN3050851OtherMEDICARE PIN