Provider Demographics
NPI:1568423861
Name:ZEMKEN, SHAUNA LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:LEE
Last Name:ZEMKEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SHAUNA
Other - Middle Name:GLENN
Other - Last Name:ZEMKEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:86 BRIGGS ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-1566
Mailing Address - Country:US
Mailing Address - Phone:518-736-1081
Mailing Address - Fax:518-736-1082
Practice Address - Street 1:86 BRIGGS ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-1566
Practice Address - Country:US
Practice Address - Phone:518-736-1081
Practice Address - Fax:518-736-1082
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0055261152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY59133OtherMVP
C4A65OtherEBCBS
000405482001OtherBSNNY
NY01492800Medicaid
NY10006286OtherCDPHP
107448OtherBCBSUW
C4A65OtherEBCBS
NY59133OtherMVP
000405482001OtherBSNNY