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NPI Code Detail

MEDICARE: MS. SHANNON RAE HARVEY OD

MEDICARE: MS. SHANNON RAE HARVEY 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
1152W00000XOptometrist2049SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12049OTHERSCOPTOMETRY LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689166019
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANNON RAE HARVEY OD
Provider Business Mailing Address
First Line : 367 W EVANS ST
Second Line :
City : FLORENCE
State : SC
Zip : 29501-3429
Country : US
Telephone Number : 843-669-4156
Fax Number : 843-664-2121
Provider Business Practice Location Address
First Line : 367 W EVANS ST
Second Line :
City : FLORENCE
State : SC
Zip : 29501-3429
Country : US
Telephone Number : 843-669-4156
Fax Number : 843-664-2121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2018
Last Update Date : 02/14/2024

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Directions to “ MS. SHANNON RAE HARVEY OD” Practice Location

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