Provider Demographics
NPI:1164595336
Name:CROZET EYE CARE, SHANNON FRANKLIN, OD, LLC
Entity Type:Organization
Organization Name:CROZET EYE CARE, SHANNON FRANKLIN, OD, LLC
Other - Org Name:CROZET EYE CARE, OPTOMETRISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:434-823-4441
Mailing Address - Street 1:300 CLAREMONT LANE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932
Mailing Address - Country:US
Mailing Address - Phone:434-823-4441
Mailing Address - Fax:434-823-7620
Practice Address - Street 1:300 CLAREMONT LANE
Practice Address - Street 2:SUITE 102
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932
Practice Address - Country:US
Practice Address - Phone:434-823-4441
Practice Address - Fax:434-823-7620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001030152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10100Medicare PIN
VA6007250001Medicare NSC