Provider Demographics
NPI:1922308196
Name:BRIDGET A. SHANNON, OD,PA
Entity Type:Organization
Organization Name:BRIDGET A. SHANNON, OD,PA
Other - Org Name:SHANNON VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-747-1122
Mailing Address - Street 1:2023 W. MCDERMOTT RD.
Mailing Address - Street 2:#100
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4677
Mailing Address - Country:US
Mailing Address - Phone:972-747-1122
Mailing Address - Fax:214-383-0838
Practice Address - Street 1:2023 W. MCDERMOTT RD.
Practice Address - Street 2:#100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4677
Practice Address - Country:US
Practice Address - Phone:972-747-1122
Practice Address - Fax:214-383-0838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5157TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0348Medicare PIN
TXV05227Medicare UPIN