Provider Demographics
NPI:1548694953
Name:BLIGDON, SHANNON M (OD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:BLIGDON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:227 PARK DR APT 44
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4790
Mailing Address - Country:US
Mailing Address - Phone:617-981-1191
Mailing Address - Fax:
Practice Address - Street 1:1245 WORCESTER ST STE 1024
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1551
Practice Address - Country:US
Practice Address - Phone:508-653-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4979152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist