Provider Demographics
NPI:1548757586
Name:HARVEY, SHAWNA (OD)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:
Other - Last Name:PFANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:999 HOME PLZ STE 100
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4822
Mailing Address - Country:US
Mailing Address - Phone:319-236-0815
Mailing Address - Fax:
Practice Address - Street 1:999 HOME PLZ STE 100
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701
Practice Address - Country:US
Practice Address - Phone:319-236-0815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092000152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist