Provider Demographics
NPI:1831194653
Name:TOOMEY-BELANGER, SHANNON C (OD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:C
Last Name:TOOMEY-BELANGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:C
Other - Last Name:TOOMEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 SPENCER DR
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-1124
Mailing Address - Country:US
Mailing Address - Phone:225-654-0603
Mailing Address - Fax:
Practice Address - Street 1:3455 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2147
Practice Address - Country:US
Practice Address - Phone:607-722-2020
Practice Address - Fax:607-722-3937
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008871152W00000X
LA1389520T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1475963Medicaid
LA1475980Medicaid
LA4B311Medicare PIN
LAU97966Medicare UPIN