Provider Demographics
NPI:1073503876
Name:SHAHEEN, THOMAS M (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:SHAHEEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1045
Mailing Address - Country:US
Mailing Address - Phone:330-923-5676
Mailing Address - Fax:330-572-2450
Practice Address - Street 1:789 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1045
Practice Address - Country:US
Practice Address - Phone:330-923-5676
Practice Address - Fax:330-572-2450
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4050/T5152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000028749OtherANTHEM
410032254OtherRAILROAD MEDICARE
OH0232644Medicaid
2289653OtherAETNA
2200835OtherUNITED HEALTHCARE
55012OtherQUALCHOICE
2200835OtherUNITED HEALTHCARE