Provider Demographics
NPI:1003836412
Name:SHULL, EMILY R (OD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:R
Last Name:SHULL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 CEI DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3311
Mailing Address - Country:US
Mailing Address - Phone:513-984-5133
Mailing Address - Fax:859-331-9040
Practice Address - Street 1:580 S LOOP RD
Practice Address - Street 2:SUITE 200
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3405
Practice Address - Country:US
Practice Address - Phone:859-331-9000
Practice Address - Fax:859-331-9040
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5574 T2488152W00000X
KY1681DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1406827Medicaid
KYP00405513OtherRAILROAD MEDICARE
OH2699567Medicaid
000000484330OtherBCBS FACET
OH1406827Medicaid
KY0656019Medicare PIN
OH4174462Medicare PIN