Provider Demographics
NPI:1144551797
Name:MITCHELL, SHANNON HAWKLEY (OD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:HAWKLEY
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5274 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WAITSFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05673-4445
Mailing Address - Country:US
Mailing Address - Phone:802-448-6988
Mailing Address - Fax:802-496-9500
Practice Address - Street 1:5274 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WAITSFIELD
Practice Address - State:VT
Practice Address - Zip Code:05673-4445
Practice Address - Country:US
Practice Address - Phone:802-448-6988
Practice Address - Fax:802-496-9500
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0068209152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management