Provider Demographics
NPI:1598102774
Name:FRIEDMEYER, SHANNON NICOLE (OD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICOLE
Last Name:FRIEDMEYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:NICOLE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6130 N LA CHOLLA BLVD STE 245
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3698
Mailing Address - Country:US
Mailing Address - Phone:205-888-6600
Mailing Address - Fax:
Practice Address - Street 1:6130 N LA CHOLLA BLVD STE 245
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3698
Practice Address - Country:US
Practice Address - Phone:205-888-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2346152W00000X
AZOPT-002530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist