Provider Demographics
NPI:1932395506
Name:STEVEN R. SHUM
Entity Type:Organization
Organization Name:STEVEN R. SHUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRISTER
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-754-6020
Mailing Address - Street 1:2109 WEST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3837
Mailing Address - Country:US
Mailing Address - Phone:901-754-6020
Mailing Address - Fax:901-754-9882
Practice Address - Street 1:2109 WEST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3837
Practice Address - Country:US
Practice Address - Phone:901-754-6020
Practice Address - Fax:901-754-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN547152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0159021OtherBLUE CROSS BLUE SHIELD
TN6172558OtherCIGNA
TN2240152OtherUNITED HEALTH CARE
TN0159021OtherBLUE CROSS BLUE SHIELD
TN2240152OtherUNITED HEALTH CARE