Evans, Shannon Marie

Evans, Shannon Marie is an sole proprietor health care provider with primary practice located at 1711 Ne 163Rd St , North Miami Beach FL 33162-4732. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Evans, Shannon Marie can be contacted via phone (302) 670-4096.

Contact Information

Primary practice address
1711 Ne 163Rd St North Miami Beach FL 33162-4732
Phone: (302) 670-4096
Fax: (305) 949-0703
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X OPC 4704 Florida

Profile Details

NPI number 1205184488
LBN Legal business name Evans, Shannon Marie
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 21st, 2012
Last updated Sep 18th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205184488 NPPES
Florida MEDICAID 014059500

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