Provider Demographics
NPI:1912913872
Name:LOONEY, SHANNON HOWARD
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:HOWARD
Last Name:LOONEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 6
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-9606
Mailing Address - Country:US
Mailing Address - Phone:276-926-4234
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 6
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-9606
Practice Address - Country:US
Practice Address - Phone:276-926-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician