Provider Demographics
NPI:1801949227
Name:DR SHEWMAKER & ASSOCIATES OPTOMETRISTS INC
Entity type:Organization
Organization Name:DR SHEWMAKER & ASSOCIATES OPTOMETRISTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:1114 FASHION RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-9609
Mailing Address - Country:US
Mailing Address - Phone:859-824-4415
Mailing Address - Fax:859-824-4497
Practice Address - Street 1:1114 FASHION RIDGE RD
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035-9609
Practice Address - Country:US
Practice Address - Phone:859-824-4415
Practice Address - Fax:859-824-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1570DT152W00000X
KY1653DT152W00000X
KY1569DT152W00000X
KY1753DT152W00000X
KYKY-1377156FX1800X
KY0938DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77001659Medicaid
KY7100057440Medicaid
KY7100172260Medicaid
KY77009389Medicaid
KY1753DTOtherSTATE LICENSE
KY45003993OtherEPSDT
KY0513102Medicare PIN
KY77009389Medicaid
KYU98063Medicare UPIN
KY7100057440Medicaid
KY0513101Medicare PIN
KY1753DTOtherSTATE LICENSE
KYV06011Medicare UPIN
KYU96711Medicare UPIN
KY77001659Medicaid
KY0513107Medicare PIN