Provider Demographics
NPI:1881785970
Name:SHOTWELL, DONNA L (OD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:SHOTWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4934 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2206
Mailing Address - Country:US
Mailing Address - Phone:941-371-7644
Mailing Address - Fax:941-371-0244
Practice Address - Street 1:4934 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2206
Practice Address - Country:US
Practice Address - Phone:941-371-7644
Practice Address - Fax:941-371-0244
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2389152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20268OtherBLUE CROSS & BLUE SHIELD
FL4568540001OtherDMERC
FL4568540001OtherDMERC
FL20268BMedicare ID - Type Unspecified