Provider Demographics
NPI:1982086286
Name:VERWOERT, SHANNON (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:VERWOERT
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 1:814 W UNIVERSITY LN UNIT 2A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1064
Mailing Address - Country:US
Mailing Address - Phone:319-521-6229
Mailing Address - Fax:
Practice Address - Street 1:4625 BLARNEY DR
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52411-8015
Practice Address - Country:US
Practice Address - Phone:319-521-6229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist