Provider Demographics
NPI:1720558661
Name:STEVENS, SHANE ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:ALAN
Last Name:STEVENS
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 WESTERN AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9563
Mailing Address - Country:US
Mailing Address - Phone:518-456-6000
Mailing Address - Fax:518-456-3426
Practice Address - Street 1:2050 WESTERN AVE STE 106
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-9563
Practice Address - Country:US
Practice Address - Phone:518-456-6000
Practice Address - Fax:518-456-3426
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0982152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist