Individual
SHANNAN ELIZABETH BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
230 E DAY RD STE 100, MISHAWAKA, IN 46545-3408
(574) 271-3939
(574) 271-3941
Mailing address
230 E DAY RD STE 100, MISHAWAKA, IN 46545-3408
(574) 271-3939
(574) 271-3941
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003466A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18003466A
LICENSE
IN
05
—
200864240
—
IN
01
—
P00991570
RR MEDICARE
IN
Enumeration date
07/02/2007
Last updated
01/23/2025
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