Provider Demographics
NPI:1538204995
Name:DANAHEY, SHAWN W (OD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:W
Last Name:DANAHEY
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 1:135 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1964
Mailing Address - Country:US
Mailing Address - Phone:815-939-2222
Mailing Address - Fax:
Practice Address - Street 1:135 W RIVER ST
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1964
Practice Address - Country:US
Practice Address - Phone:815-939-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008524152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMD0211007OtherDEA
IL371020Medicare ID - Type Unspecified
U43072Medicare UPIN