Provider Demographics
NPI:1518745082
Name:LOCKLEAR, SHON ERIC
Entity Type:Individual
Prefix:
First Name:SHON
Middle Name:ERIC
Last Name:LOCKLEAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3568 UNION CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-8260
Mailing Address - Country:US
Mailing Address - Phone:910-740-9904
Mailing Address - Fax:
Practice Address - Street 1:3568 UNION CHAPEL RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8260
Practice Address - Country:US
Practice Address - Phone:910-740-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71013171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications