Provider Demographics
NPI:1518325257
Name:CHIERICHETTI, SHANNON (LDO, NCLE, ABO)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CHIERICHETTI
Suffix:
Gender:F
Credentials:LDO, NCLE, ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7109
Mailing Address - Country:US
Mailing Address - Phone:360-461-4035
Mailing Address - Fax:
Practice Address - Street 1:20 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7109
Practice Address - Country:US
Practice Address - Phone:360-461-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO60241913156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician