Provider Demographics
NPI:1255823969
Name:STUDER, SHANNA RENAE (OD)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:RENAE
Last Name:STUDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:RENAE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:10 TAFT ST S
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-2037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 TAFT ST. S
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548
Practice Address - Country:US
Practice Address - Phone:515-332-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091469152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist