Provider Demographics
NPI:1396375077
Name:SHAVER, JANICE REN (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:REN
Last Name:SHAVER
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3684
Mailing Address - Country:US
Mailing Address - Phone:716-898-2002
Mailing Address - Fax:716-926-6310
Practice Address - Street 1:12657 SENECA RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9707
Practice Address - Country:US
Practice Address - Phone:716-934-3300
Practice Address - Fax:716-934-2040
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254155207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology