Provider Demographics
NPI:1982874251
Name:LEE SHUWARGER, OD PC
Entity Type:Organization
Organization Name:LEE SHUWARGER, OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUWARGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:806-351-1144
Mailing Address - Street 1:3130 S SONCY RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2011
Mailing Address - Country:US
Mailing Address - Phone:806-354-1144
Mailing Address - Fax:806-353-1190
Practice Address - Street 1:3130 S SONCY RD
Practice Address - Street 2:SUITE 500
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2011
Practice Address - Country:US
Practice Address - Phone:806-354-1144
Practice Address - Fax:806-353-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4546T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112449703Medicaid
TX112449703Medicaid
TX8A3031Medicare PIN