Physician Compare National (NPI:1255823969)

HEALTHCARE PROVIDER: SHANNA RENAE STUDER O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1255823969
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274884465
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180927001469
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	STUDER
	Individual professional last name
Provider First Name	SHANNA
	Individual professional first name
Provider Middle Name	RENAE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
	Individual professional's medical school
Graduation Year	2018
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	10 TAFT S ST
	Group Practice or individual's line 1 address
Line 2 Street Address	THREE RIVERS EYE CARE
	Group Practice or individual's line 2 address
City	HUMBOLDT
	Group Practice or individual's city
State	IA
	Group Practice or individual's state
Zip Code	505482037
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y