Provider Demographics
NPI:1285066720
Name:SHANNON S. SUH, O.D., PA
Entity type:Organization
Organization Name:SHANNON S. SUH, O.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:SUMI
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-731-8677
Mailing Address - Street 1:8801 OHIO DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2268
Mailing Address - Country:US
Mailing Address - Phone:972-731-8677
Mailing Address - Fax:972-731-8635
Practice Address - Street 1:8801 OHIO DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2268
Practice Address - Country:US
Practice Address - Phone:972-731-8677
Practice Address - Fax:972-731-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5808T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX919792OtherBLOCKVISION
TX0018FFOtherBLUE CROSS BLUE SHIELD