Provider Demographics
NPI:1861988610
Name:HOWELL, SHANNON ALISHA (OD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ALISHA
Last Name:HOWELL
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 1:1020 TERRACE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4392
Mailing Address - Country:US
Mailing Address - Phone:276-783-5157
Mailing Address - Fax:
Practice Address - Street 1:1020 TERRACE DR STE 100
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4392
Practice Address - Country:US
Practice Address - Phone:276-783-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0618002689OtherOPTOMETRY LISCENSE NUMBER