MEDICARE: DR. DARRIN C. SHANDLEY OD

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	9453T	TX

General Provider Information

NPI Number	:	1467938878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRIN C. SHANDLEY OD

Provider Business Mailing Address
First Line	:	120 HIGHWAY 332 W STE A5
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-4017
Country	:	US
Telephone Number	:	979-297-8188
Fax Number	:	979-297-5410

Provider Business Practice Location Address
First Line	:	120 HIGHWAY 332 W STE A5
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-4017
Country	:	US
Telephone Number	:	979-297-8188
Fax Number	:	979-297-5410

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

Provider Enumeration Date	:	07/18/2018
Last Update Date	:	09/29/2020

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