Provider Demographics
NPI:1821303652
Name:DURRANT, SHANE ONIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:ONIEL
Last Name:DURRANT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14230 NE 20TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3745
Mailing Address - Country:US
Mailing Address - Phone:614-493-6440
Mailing Address - Fax:
Practice Address - Street 1:14230 NE 20TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3745
Practice Address - Country:US
Practice Address - Phone:425-748-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60189678152W00000X
OH5856152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH43211305OtherPTAN / BEECHMONT
OH43211306OtherPTAN / TRI COUNTY
OH43211303OtherPTAN / KENWOOD
OH43211304OtherPTAN / HAMILTON
OH43211307OtherPTAN / SYMMES
OH43211308OtherPTAN / LIBERTY
KYP400042110OtherPTAN / KENTUCKY
OH43211302OtherPTAN / GLENWAY
OH43211302OtherPTAN / HYDE PARK
OH43211301OtherPTAN / COLERAIN