Provider Demographics
NPI:1730389347
Name:SHUMAKER, JEREMY ROSS (OD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ROSS
Last Name:SHUMAKER
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 1:361 3RD ST STE C
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3580
Mailing Address - Country:US
Mailing Address - Phone:415-459-2020
Mailing Address - Fax:415-459-2020
Practice Address - Street 1:361 3RD ST STE C
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3580
Practice Address - Country:US
Practice Address - Phone:415-459-2020
Practice Address - Fax:415-459-2021
Is Sole Proprietor?:No
Enumeration Date:2007-07-21
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13336T152WP0200X, 152WS0006X, 152WV0400X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy