Provider Demographics
NPI:1144225152
Name:SHENKLE, LINDA SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUE
Last Name:SHENKLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:SUE
Other - Last Name:TOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1050 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-3442
Mailing Address - Country:US
Mailing Address - Phone:716-465-7139
Mailing Address - Fax:
Practice Address - Street 1:2825 NIAGARA FALLS BLVD
Practice Address - Street 2:STE 130
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2021
Practice Address - Country:US
Practice Address - Phone:716-564-2020
Practice Address - Fax:716-564-2060
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005071-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161578122OtherNORTH AMERICAN PREFERRED
NY161578122OtherNOVA
NY000390043002OtherCOMMUNITY BLUE
NY02505984Medicaid
NY251744484OtherEMPIRE - UNITED HEALTHCAR
NY000390043004OtherCOMMUNITY BLUE
NY251744484OtherNOVA
NY410042274OtherMEDICARE RAILROAD
NY161578122OtherEMPIRE - UNITED HEALTHCAR
NY251744484OtherNORTH AMERICAN PREFERRED
NYU36122Medicare UPIN
NYBB5261Medicare PIN
NY410042274OtherMEDICARE RAILROAD