Provider Demographics
NPI:1619148103
Name:DORLON, SHANNA
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:DORLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 BRANSON HILLS PKWY
Mailing Address - Street 2:SUITE N
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-9940
Mailing Address - Country:US
Mailing Address - Phone:417-336-1801
Mailing Address - Fax:417-336-1803
Practice Address - Street 1:1077 BRANSON HILLS PKWY
Practice Address - Street 2:SUITE N
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-9940
Practice Address - Country:US
Practice Address - Phone:417-336-1801
Practice Address - Fax:417-336-1803
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0800011732156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician