Provider Demographics
NPI:1275682973
Name:SHNAY, ALAN B (OD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:B
Last Name:SHNAY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1619
Mailing Address - Country:US
Mailing Address - Phone:708-747-6449
Mailing Address - Fax:
Practice Address - Street 1:225 LINCOLN MALL
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2331
Practice Address - Country:US
Practice Address - Phone:708-481-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU80070Medicare UPIN
ILL77901Medicare ID - Type Unspecified