Provider Demographics
NPI:1912905126
Name:SHEWEY, WILLIAM BRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRIAN
Last Name:SHEWEY
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 1:615 E OKLAHOMA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5951
Mailing Address - Country:US
Mailing Address - Phone:580-233-4711
Mailing Address - Fax:580-234-6686
Practice Address - Street 1:615 E OKLAHOMA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5951
Practice Address - Country:US
Practice Address - Phone:580-233-4711
Practice Address - Fax:580-234-6686
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKM1427453188Medicaid
OK0748750001OtherCIGNA DMERC
OK410018675OtherRAILROAD MEDICARE
OKU20121Medicare UPIN