1730138942

Everything you always wanted to know about DR. EVANS M SHANE OD but were afraid to ask.

DR. EVANS M SHANE OD

You can also download the this 1730138942 data report as csv | excel | json | xml
Provider Prefix Provider Last Name Provider Middle Name Provider First Name Provider Credential
DR. EVANS M SHANE OD
Gender:
Male
Enumeration date:
2006-05-08
Last update date:
2008-02-19
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
Yes
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Identifiers

identifier description issuer state
3065482 Medicaid none IA
2065482 Medicaid none IA
0065482 Medicaid none IA

Taxonomies

Taxonomy State License Number Primary?
152W00000X Optometrist IA 01940 Y

Phone Numbers

Type Number
Mailing Address Telephone Number 5152250877
Practice Location Address Telephone Number 5152250877
Mailing Address Fax Number 5152259518
Practice Location Address Fax Number 5152259518

Addresses

Type Address City State Postal Country
Mailing Address 1905 E P TRUE PARKWAY STE 103 WEST DES MOINES IA 50265 IA
Practice Location Address 1905 E P TRUE PARKWAY STE 103 WEST DES MOINES IA 50265 IA

Other NPI Records that share a phone number

NPI Name Address State City
1073544201 EYE CARE OF IOWA P.C.
Organization
1905 EP TRUE PKWY IA WEST DES MOINES
1104875319 NESHEIM, JASON
Individual
1905 E P TRUE PARKWAY IA WEST DES MOINES

Other NPI Records that share an address

NPI Name Address State City
1104875319 NESHEIM, JASON
Individual
1905 E P TRUE PARKWAY IA WEST DES MOINES