Provider Demographics
NPI:1578582581
Name:MCCARTHY, SHEMAYNE JAHNER (OD)
Entity Type:Individual
Prefix:DR
First Name:SHEMAYNE
Middle Name:JAHNER
Last Name:MCCARTHY
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 1:10481 N SAGE HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-9575
Mailing Address - Country:US
Mailing Address - Phone:208-362-5481
Mailing Address - Fax:
Practice Address - Street 1:440 E STATE ST STE 140
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5935
Practice Address - Country:US
Practice Address - Phone:208-939-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-993152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1593347Medicare PIN
IDU77762Medicare UPIN