Provider Demographics
NPI:1245962141
Name:ROBINSON, SHANNON KELSEY (OD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:KELSEY
Last Name:ROBINSON
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 1:1385 STONE CREEK LN APT 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-7166
Mailing Address - Country:US
Mailing Address - Phone:717-623-7426
Mailing Address - Fax:
Practice Address - Street 1:6946 FOREST AVE # 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1701
Practice Address - Country:US
Practice Address - Phone:804-287-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist