Healthcare Provider Details

I. General information

NPI: 1134265838
Provider Name (Legal Business Name): SHANA D. HUNT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 S MARION ST
MARTINSVILLE IN
46151-2438
US

IV. Provider business mailing address

356 S DENNY HILL RD
PARAGON IN
46166-9482
US

V. Phone/Fax

Practice location:
  • Phone: 765-342-5497
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002468B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: