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General NPI Number Information
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NPI Number | 1821353566
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Entity Type | Individual
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Provider Name | SHANNON LEIGH BROWN BLACKWOOD OD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 645 PATTON AVE
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City | ASHEVILLE
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State | NC
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Zip | 28806-3834
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Country | US
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Telephone | 828-251-1290
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Fax |
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Provider Business Mailing Address
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Address Line | 107 SUMMERGLEN DR
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City | ASHEVILLE
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State | NC
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Zip | 28806-9524
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Country | US
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Telephone | 803-984-0671
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Fax |
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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 | 1701
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2270
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License Number State | NC
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