Provider Demographics
NPI:1881797108
Name:SHOOK, STEVE R (OD)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:R
Last Name:SHOOK
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 1:1014 W 29TH ST S
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-3114
Mailing Address - Country:US
Mailing Address - Phone:316-613-2033
Mailing Address - Fax:316-613-2237
Practice Address - Street 1:1014 W 29TH ST S
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-3114
Practice Address - Country:US
Practice Address - Phone:316-613-2033
Practice Address - Fax:316-613-2237
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2013-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1076-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist