Provider Demographics
NPI:1871678417
Name:PIERCE, SHANNON C (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:C
Last Name:PIERCE
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 W OAK ST
Practice Address - Street 2:STE 100
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1840
Practice Address - Country:US
Practice Address - Phone:317-873-4020
Practice Address - Fax:317-873-1030
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002431A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000537888OtherANTHEM
ININ2431OtherEYEMED
IN26-0196645OtherVSP
INU29277Medicare UPIN
IN26-0196645OtherVSP
IN252860AMedicare PIN