Provider Demographics
NPI:1831118447
Name:SCHEUREN, SHANNON TARA (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:TARA
Last Name:SCHEUREN
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 1:419 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17921-2107
Mailing Address - Country:US
Mailing Address - Phone:570-875-2504
Mailing Address - Fax:
Practice Address - Street 1:324 E INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-6710
Practice Address - Country:US
Practice Address - Phone:570-648-4747
Practice Address - Fax:570-648-3100
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001760262Medicaid
PA397037OtherNVA
PA636139OtherBC/BS NE PA
PA809208OtherFIRST PRIORITY HEALTH
PA636139OtherBC/BS NE PA
PA001760262Medicaid
PA033676J46Medicare PIN