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General NPI Number Information
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NPI Number | 1407162852
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Entity Type | Individual
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Provider Name | SHANAR H LOU O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 10/15/2013
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Provider Practice Location Address
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Address Line | 1001 WIDEWATERS PKWY
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City | KNIGHTDALE
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State | NC
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Zip | 27545-6102
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Country | US
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Telephone | 919-861-2020
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Fax | 919-277-0854
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Provider Business Mailing Address
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Address Line | 7100 SIX FORKS RD SUITE 301
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City | RALEIGH
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State | NC
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Zip | 27615-6156
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Country | US
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Telephone | 919-847-0187
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Fax | 919-676-2231
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2205
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License Number State | NC
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