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General NPI Number Information
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NPI Number | 1790289510
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Entity Type | Individual
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Provider Name | SHANA THEDFORD RO
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Gender | Female
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 3304 8TH ST
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City | MERIDIAN
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State | MS
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Zip | 39301-4755
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Country | US
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Telephone | 844-225-7160
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Fax | 386-343-7195
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Provider Business Mailing Address
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Address Line | 3220 LAUDERDALE RD
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City | LAUDERDALE
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State | MS
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Zip | 39335-9639
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Country | US
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Telephone | 601-616-1210
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Fax | 601-483-7983
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 156FX1101X
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Taxonomy Name | Ophthalmic Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 156FC0800X
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Taxonomy Name | Contact Lens Technician/Technologist
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License Number |
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 156FX1101X
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Taxonomy Name | Ophthalmic Assistant
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License Number |
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License Number State | MS
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Taxonomy #6
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State | MS
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