Provider Demographics
NPI:1235659988
Name:SHUDER, ERICA JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:JEAN
Last Name:SHUDER
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 1:4 TAMMI CT
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-5035
Mailing Address - Country:US
Mailing Address - Phone:631-269-7067
Mailing Address - Fax:
Practice Address - Street 1:536 ROUTE 111
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4346
Practice Address - Country:US
Practice Address - Phone:631-265-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV-008600-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist