Provider Demographics
NPI:1609095090
Name:ALTURAS, SHANNON OLARIO (OD)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:OLARIO
Last Name:ALTURAS
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 1:3658 S NOGALES ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2714
Mailing Address - Country:US
Mailing Address - Phone:626-539-3543
Mailing Address - Fax:866-597-7977
Practice Address - Street 1:3658 S NOGALES ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-2714
Practice Address - Country:US
Practice Address - Phone:626-539-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12898T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMA1297464OtherDEA
CAMA1297464OtherDEA
CAV07619Medicare UPIN