Active NPI
Shawn Mitchell McDonald, OD
- Optometrist
- Placerville, CA
National Provider Identifier
1710037445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 8543
- Practice address
- 2802 Mallard Lane
Placerville, CA 95667 - Phone
- (530) 626-8440
- Fax
- (530) 626-1897
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 8543 | CA | Primary |
Addresses
Primary practice location
2802 Mallard Lane
Placerville, CA 95667
Mailing address
2802 Mallard Lane
Placerville, CA 95667
Phone (530) 626-8440
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100407000196 | CA | Practitioner - Optometry | 3173659703 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8543 | CA | MD | Hearing Instrument Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254873600000",
"number": "1710037445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2802 MALLARD LANE",
"city": "PLACERVILLE",
"state": "CA",
"postal_code": "95667",
"telephone_number": "530-626-8440",
"fax_number": "530-626-1897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2802 MALLARD LANE",
"city": "PLACERVILLE",
"state": "CA",
"postal_code": "95667",
"telephone_number": "530-626-8440",
"fax_number": "530-626-1897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONALD",
"first_name": "SHAWN",
"middle_name": "MITCHELL",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2009-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "8543",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Placerville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.