Provider Demographics
NPI:1497982243
Name:JENNIFER L. SHANE, O.D., LTD
Entity Type:Organization
Organization Name:JENNIFER L. SHANE, O.D., LTD
Other - Org Name:DR. JENNIFER L. SHANE AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHANE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-826-4100
Mailing Address - Street 1:4790 CAUGHLIN PARKWAY #329
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0907
Mailing Address - Country:US
Mailing Address - Phone:775-826-4100
Mailing Address - Fax:775-826-4138
Practice Address - Street 1:5465 MEADOWOOD MALL CIR STE B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6570
Practice Address - Country:US
Practice Address - Phone:775-826-4100
Practice Address - Fax:775-826-4138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
NV687152W00000X
NV399152W00000X
NV379152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty