Healthcare Provider Details

I. General information

NPI: 1134773534
Provider Name (Legal Business Name): SHANNON WORTHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON KIRCHMER OD

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MOUNT PLEASANT RD
CHESAPEAKE VA
23322-4152
US

IV. Provider business mailing address

200 W WEAVER ST STE 100
CARRBORO NC
27510-6009
US

V. Phone/Fax

Practice location:
  • Phone: 757-482-4022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2719
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002807
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: