MEDICARE: SHANNON WORTHINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2719	NC
2	152W00000X	Optometrist	0618002807	VA

General Provider Information

NPI Number	:	1134773534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON WORTHINGTON

Provider Business Mailing Address
First Line	:	200 W WEAVER ST STE 100
Second Line	:
City	:	CARRBORO
State	:	NC
Zip	:	27510-6009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 MOUNT PLEASANT RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-4152
Country	:	US
Telephone Number	:	757-482-4022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2019
Last Update Date	:	03/02/2026

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Directions to “ SHANNON WORTHINGTON ” Practice Location

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