Provider Demographics
NPI:1740757517
Name:HONEYCUTT, SHANNON NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:NICOLE
Last Name:HONEYCUTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:67 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-1514
Mailing Address - Country:US
Mailing Address - Phone:330-551-5024
Mailing Address - Fax:330-551-5220
Practice Address - Street 1:67 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-1514
Practice Address - Country:US
Practice Address - Phone:330-551-5024
Practice Address - Fax:330-551-5220
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist