Provider Demographics
NPI:1003836412
Name:SHULL, EMILY R (OD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:R
Last Name:SHULL
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 1:500 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4422
Mailing Address - Country:US
Mailing Address - Phone:513-821-1200
Mailing Address - Fax:513-821-2400
Practice Address - Street 1:500 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-4422
Practice Address - Country:US
Practice Address - Phone:513-821-1200
Practice Address - Fax:513-821-2400
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5574 T2488152W00000X
KY1681DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1406827Medicaid
KYP00405513OtherRAILROAD MEDICARE
OH2699567Medicaid
000000484330OtherBCBS FACET
OH1406827Medicaid
KY0656019Medicare PIN
OH4174462Medicare PIN