Provider Demographics
NPI:1073210670
Name:BACKES, SHAWN K (LDO)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:K
Last Name:BACKES
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3433
Mailing Address - Country:US
Mailing Address - Phone:419-698-8584
Mailing Address - Fax:419-698-8907
Practice Address - Street 1:3721 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3433
Practice Address - Country:US
Practice Address - Phone:419-698-8584
Practice Address - Fax:419-698-8907
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.10614SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician