Provider Demographics
NPI:1437193299
Name:MCCANN, SHANNON L (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:L
Last Name:MCCANN
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:C/O EMPIRE VISION CENTER, INC
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1430
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:700 BOSTON RD
Practice Address - Street 2:MASS OPTOMETRIC ASSOCIATES, P.C.
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-5316
Practice Address - Country:US
Practice Address - Phone:978-667-0481
Practice Address - Fax:978-670-7778
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V07621Medicare UPIN
SAW17617Medicare ID - Type Unspecified