Individual provider Active NPI

Shelby Taylor Jueneman, OD

  • Optometrist
  • Manhattan, KS
National Provider Identifier
1194456590
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2173 Issued in KS
Practice address
2012 Vanesta PL Ste 210
Manhattan, KS 66503-4101
Phone
(785) 539-8019
NPI assigned
Jun 17, 2022
Last updated
Aug 11, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2173 KS Primary

Addresses

Primary practice location

2012 Vanesta PL Ste 210
Manhattan, KS 66503-4101

Mailing address

101 Bluemont Ave Ste C
Manhattan, KS 66502-5093
Phone (785) 539-8019

Other practice location 1

101 Bluemont Ave Ste C
Manhattan, KS 66502-5093
Phone (785) 539-8019

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220926001455 KS Practitioner - Optometry 7517342413 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wainwright Eye Care PAGroup PAC ID 3678725132, 3 clinicians

Practice addresses (Care Compare)

2012 Vanesta PL
Suite 210
Manhattan, KS 66503-4101
Phone (785) 539-8019

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1194456590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BLUEMONT AVE STE C",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665025093",
            "telephone_number": "785-539-8019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2012 VANESTA PL STE 210",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665034101",
            "telephone_number": "785-539-8019"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Bluemont Ave Ste C",
            "address_purpose": "LOCATION",
            "city": "Manhattan",
            "state": "KS",
            "postal_code": "665025093",
            "country_code": "US",
            "telephone_number": "785-539-8019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUENEMAN",
        "first_name": "SHELBY",
        "middle_name": "TAYLOR",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-17",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KS",
            "license": "2173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manhattan, KS

Sources for this page

Verify at the official NPI Registry.