Provider Demographics
NPI:1477818078
Name:SHAY, COURTNEY (OD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:SHAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 OLD KEENE MILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4284
Mailing Address - Country:US
Mailing Address - Phone:703-569-3131
Mailing Address - Fax:
Practice Address - Street 1:9314 OLD KEENE MILL RD STE A
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4284
Practice Address - Country:US
Practice Address - Phone:703-569-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist