Provider Demographics
NPI:1821795840
Name:BOYKIN, SHANNON
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:COFFEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1890 MCTAGGART DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3920
Mailing Address - Country:US
Mailing Address - Phone:330-858-1196
Mailing Address - Fax:
Practice Address - Street 1:4141 PEARL RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-7649
Practice Address - Country:US
Practice Address - Phone:330-723-0234
Practice Address - Fax:330-723-1608
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.014051156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician