Provider Demographics
NPI:1942841754
Name:SHANNON MOORE, O.D., P.C.
Entity Type:Organization
Organization Name:SHANNON MOORE, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:JESSICA
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-347-0555
Mailing Address - Street 1:528 WATERLOO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3011
Mailing Address - Country:US
Mailing Address - Phone:540-347-0555
Mailing Address - Fax:540-347-9198
Practice Address - Street 1:528 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3011
Practice Address - Country:US
Practice Address - Phone:540-347-0555
Practice Address - Fax:540-347-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty