Provider Demographics
NPI:1407945819
Name:SUH, SHANNON SUMI (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:SUMI
Last Name:SUH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:SUMI
Other - Last Name:SUH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1950 OLD GALLOWS RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3990
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:972-731-8635
Practice Address - Street 1:44727 BRIMFIELD DR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5920
Practice Address - Country:US
Practice Address - Phone:571-385-4600
Practice Address - Fax:571-385-4605
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5808T152W00000X
VA5808T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018FFOtherBLUE CROSS BLUE SHIELD
TX12969OtherSPECTERA
TX919792OtherBLOCKVISON
TX48962OtherDAVIS VISION