Provider Demographics
NPI:1649398504
Name:HUNTZBERRY, SHANNON DENYSE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:DENYSE
Last Name:HUNTZBERRY
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 1:110 S PANTOPS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8672
Mailing Address - Country:US
Mailing Address - Phone:434-977-2020
Mailing Address - Fax:434-977-4842
Practice Address - Street 1:2159 BARRACKS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4812
Practice Address - Country:US
Practice Address - Phone:434-977-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2022152W00000X
MA4614152WC0802X
VA0618002109152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management