Provider Demographics
NPI:1801193917
Name:SHOFNER, JANIE M (COA)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:M
Last Name:SHOFNER
Suffix:
Gender:F
Credentials:COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20488
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-0488
Mailing Address - Country:US
Mailing Address - Phone:405-751-2014
Mailing Address - Fax:405-751-3838
Practice Address - Street 1:11013 HEFNER POINTE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5035
Practice Address - Country:US
Practice Address - Phone:405-751-2014
Practice Address - Fax:405-751-3838
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician