Provider Demographics
NPI:1295748663
Name:KERNS, SHANNON CHERIE (OD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:CHERIE
Last Name:KERNS
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 1:7708 LOHMANS FORD RD STE 102B
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-4794
Mailing Address - Country:US
Mailing Address - Phone:512-267-7700
Mailing Address - Fax:512-267-7715
Practice Address - Street 1:7708 LOHMANS FORD RD
Practice Address - Street 2:BLDG., B, SUITE 102
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-4781
Practice Address - Country:US
Practice Address - Phone:512-267-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6895T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist