MEDICARE: SHAMONE BENNETT

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	156FX1800X	Optician	OP-10057S	OH

General Provider Information

NPI Number	:	1841143369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMONE BENNETT

Provider Business Mailing Address
First Line	:	4662 RHODE ISLAND DR
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44515-4416
Country	:	US
Telephone Number	:	330-774-8589
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 DORAL DR
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44514-1900
Country	:	US
Telephone Number	:	330-758-0708
Fax Number	:

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

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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Directions to “ SHAMONE BENNETT ” Practice Location

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