MEDICARE: DR. SHANNON ELIZABETH O'HARE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	6239T	TX

General Provider Information

NPI Number	:	1275500845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON ELIZABETH O'HARE O.D.

Provider Business Mailing Address
First Line	:	1830 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-1819
Country	:	US
Telephone Number	:	214-226-1538
Fax Number	:

Provider Business Practice Location Address
First Line	:	1546 STACY RD
Second Line	:	SUITE 100
City	:	ALLEN
State	:	TX
Zip	:	75002-8726
Country	:	US
Telephone Number	:	214-226-1538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	01/03/2019

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