Provider Demographics
NPI:1144420142
Name:SCHUG, SHANNON LYN (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LYN
Last Name:SCHUG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:LYN
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6473 PEBBLE CT
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5561
Mailing Address - Country:US
Mailing Address - Phone:716-713-0948
Mailing Address - Fax:
Practice Address - Street 1:945 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-1218
Practice Address - Country:US
Practice Address - Phone:716-845-6080
Practice Address - Fax:716-845-0167
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007147-1152W00000X
OH6347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist