Provider Demographics
NPI:1720009905
Name:GATRELL, SHANNON E (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:E
Last Name:GATRELL
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 1:269 ROCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8535
Mailing Address - Country:US
Mailing Address - Phone:503-866-0280
Mailing Address - Fax:
Practice Address - Street 1:2811 W 10TH AVE STE C
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-4672
Practice Address - Country:US
Practice Address - Phone:509-734-2511
Practice Address - Fax:509-734-1632
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00004060152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist