Provider Demographics
NPI:1134263528
Name:SHOVER, JAMES GERALD (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GERALD
Last Name:SHOVER
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 1:7070 BUTCHER KNIFE RD NE
Mailing Address - Street 2:P.O BOX 0799
Mailing Address - City:SOMERSET
Mailing Address - State:OH
Mailing Address - Zip Code:43783-9545
Mailing Address - Country:US
Mailing Address - Phone:740-743-2243
Mailing Address - Fax:
Practice Address - Street 1:123 MILL ST
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-1341
Practice Address - Country:US
Practice Address - Phone:740-743-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0153971Medicaid
OHSHO573501Medicare ID - Type Unspecified
OH0153971Medicaid