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General NPI Number Information
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NPI Number | 1548776024
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Entity Type | Organization
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Legal Business Name | JENNIFER L. SHANE O.D., LTD
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 5385 RENO CORPORATE DRIVE #100
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City | RENO
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State | NV
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Zip | 89511
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Country | US
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Telephone | 775-313-5146
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Fax |
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Provider Business Mailing Address
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Address Line | 4790 CAUGHLIN PKWY # 329
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City | RENO
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State | NV
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Zip | 89519-0907
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Country | US
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Telephone | 775-852-3937
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Fax | 775-683-3231
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER SHANE
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Credential | OD
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Telephone | 775-852-3937
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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 |
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License Number State | NV
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