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
2065482 Medicaid none IA
410017958 Medicare PIN none none
06324 Medicare PIN none none
410029175 Medicare PIN none none
410029173 Medicare PIN none none
410029174 Medicare PIN none none
09209 Medicare PIN none none
U00940 Medicare UPIN none none
3065482 Medicaid none IA
I8289 Medicare PIN none none
0065482 Medicaid none IA
07227 Medicare PIN none none

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