Healthcare Provider Details

I. General information

NPI: 1043664071
Provider Name (Legal Business Name): SHANNON HILLIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10459 DOUBLE R BLVD
RENO NV
89521-8905
US

IV. Provider business mailing address

10459 DOUBLE R BLVD
RENO NV
89521-8905
US

V. Phone/Fax

Practice location:
  • Phone: 775-827-3030
  • Fax:
Mailing address:
  • Phone: 775-827-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4297ATI
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberATI-4297
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1123
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: