Active NPI
Erica Jean Shuder, OD
- Optometrist
- Hauppauge, NY
National Provider Identifier
1235659988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TUV-008600-1
- Practice address
- 536 Route 111
Hauppauge, NY 11788-4346 - Phone
- (631) 265-4700
- NPI assigned
- Jun 23, 2017
- Last updated
- Jun 23, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV-008600-1 | NY | Primary |
Addresses
Primary practice location
536 Route 111
Hauppauge, NY 11788-4346
Mailing address
4 Tammi CT
Kings Park, NY 11754-5035
Phone (631) 269-7067
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TUV-008600-1 | NY | MD | Optometrist |
| 008600 | NY | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| King Family Eye Care, LLC | Optometrist | Current | Accepting new patients |
| Empire Vision Center, Inc | Current | Accepting new patients | |
| Empire Vision Center Inc | Optometrist | Current | Accepting new patients |
| Town Line Eye Care, LLC | Optometrist | Current | Accepting new patients |
| Empire Vision Center Inc | Optometrist | Past | Accepting new patients |
Locations
761 Boston Post Rd
Old Saybrook, CT 06475
Phone (860) 388-9300
80 Town Line Rd
Rocky Hill, CT 06067
Phone (860) 258-2380
1930 South Rd
#105
Poughkeepsie, NY 12601
Phone (845) 298-3200
Organizations & group practices 5
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.
-
- Optometrist
- Old Saybrook, CT
- NPI 1508925330
-
dba Davis Vision
- Technician/Technologist
- Hauppauge, NY
- NPI 1699738005
Optometrist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498176000000",
"number": "1235659988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 TAMMI CT",
"city": "KINGS PARK",
"state": "NY",
"postal_code": "117545035",
"telephone_number": "631-269-7067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "536 ROUTE 111",
"city": "HAUPPAUGE",
"state": "NY",
"postal_code": "117884346",
"telephone_number": "631-265-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUDER",
"first_name": "ERICA",
"middle_name": "JEAN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-23",
"last_updated": "2017-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV-008600-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hauppauge, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.