Provider Demographics
NPI:1548315070
Name:MCSHAN, NANCY NELL (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:NELL
Last Name:MCSHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 PEBBLEHILL DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-2323
Mailing Address - Country:US
Mailing Address - Phone:901-388-2332
Mailing Address - Fax:901-386-0338
Practice Address - Street 1:3624 AUSTIN PEAY HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3776
Practice Address - Country:US
Practice Address - Phone:901-386-5031
Practice Address - Fax:901-386-0338
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001241152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU35185Medicare UPIN
TN3598467Medicare ID - Type Unspecified