1215915590 NPI number — DR. SHANNON BELINDA FARR OD

Table of content: DR. SHANNON BELINDA FARR OD (NPI 1215915590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215915590 NPI number — DR. SHANNON BELINDA FARR OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARR
Provider First Name:
SHANNON
Provider Middle Name:
BELINDA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215915590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
12/13/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3245 HOSPITAL DRIVE
Provider Second Line Business Mailing Address:
SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM
Provider Business Mailing Address City Name:
JUNEAU
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-463-4086
Provider Business Mailing Address Fax Number:
907-463-6618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HARBOR VIEW EYE CARE, LLC.
Provider Second Line Business Practice Location Address:
743 BROADWAY
Provider Business Practice Location Address City Name:
SOUTH PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-799-3031
Provider Business Practice Location Address Fax Number:
207-799-9005
Provider Enumeration Date:
01/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0ET009051 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OE007953P , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 264 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OD52481 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".