Provider Demographics
NPI:1396880373
Name:FEELEY, SHAWNA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:MARIE
Last Name:FEELEY
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 1:321 MIDWAY MEDICAL PARK
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1651
Mailing Address - Country:US
Mailing Address - Phone:423-968-3441
Mailing Address - Fax:423-968-5674
Practice Address - Street 1:321 MIDWAY MEDICAL PARK
Practice Address - Street 2:SUITE 2
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1651
Practice Address - Country:US
Practice Address - Phone:423-968-3441
Practice Address - Fax:423-968-5674
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT1902152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3943335Medicaid
TNU53600Medicare UPIN
TN3943335Medicaid