Provider Demographics
NPI:1255349635
Name:COMPTON, SHANNON LEIGH (OD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:COMPTON
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:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-1000
Mailing Address - Country:US
Mailing Address - Phone:434-846-7822
Mailing Address - Fax:434-846-8107
Practice Address - Street 1:5076 S. AMHERST HWY
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-1000
Practice Address - Country:US
Practice Address - Phone:434-846-7822
Practice Address - Fax:434-846-8107
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009234357Medicaid
VA410001079Medicare PIN
C05874Medicare UPIN
VA1252770001Medicare NSC