MEDICARE: SHANNON O. ALTURAS, O.D., A PROFESSIONAL CORPORATION

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	12898 T	CA

General Provider Information

NPI Number	:	1912203787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANNON O. ALTURAS, O.D., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3658 S NOGALES ST
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91792-2714
Country	:	US
Telephone Number	:	626-539-3543
Fax Number	:	866-597-7977

Provider Business Practice Location Address
First Line	:	3658 S NOGALES ST
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91792-2714
Country	:	US
Telephone Number	:	626-539-3543
Fax Number	:	866-597-7977

Authorized Official
Title or Position	:	CEO
Name	:	DR. SHANNON OLARIO ALTURAS
Credential	:	O.D.
Telephone Number	:	626-539-3543

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	08/04/2011

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