Provider Demographics
NPI:1568516342
Name:ELWOOD, SHANNON (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:ELWOOD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 FARNAM ST
Mailing Address - Street 2:STE 7103
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-3569
Mailing Address - Country:US
Mailing Address - Phone:402-502-7323
Mailing Address - Fax:402-502-7776
Practice Address - Street 1:8013 N 164TH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-5569
Practice Address - Country:US
Practice Address - Phone:402-203-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist