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NPI Code Detail

MEDICARE: SHANNON KAY DITTMANN O.D.

MEDICARE: SHANNON KAY DITTMANN 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
1152W00000XOptometrist4922OH

General Provider Information

NPI Number : 1821274853
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON KAY DITTMANN O.D.
Provider Business Mailing Address
First Line : 7840 MONTGOMERY RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45236-4301
Country : US
Telephone Number : 513-794-9964
Fax Number :
Provider Business Practice Location Address
First Line : 7840 MONTGOMERY RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45236-4301
Country : US
Telephone Number : 513-794-9964
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2008
Last Update Date : 01/22/2008

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