Provider Demographics
NPI:1578851341
Name:HEISS, SHANNON L (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:L
Last Name:HEISS
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 1:3612 N 165TH ST STE 139
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-6459
Mailing Address - Country:US
Mailing Address - Phone:402-916-9822
Mailing Address - Fax:
Practice Address - Street 1:3612 N 165TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-6459
Practice Address - Country:US
Practice Address - Phone:402-916-9822
Practice Address - Fax:402-502-7776
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist