Individual
SHANNON LEIGH DEITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
13900 E US HIGHWAY 40 STE A, INDEPENDENCE, MO 64055-5877
(816) 478-0500
Mailing address
13120 LARSEN ST, OVERLAND PARK, KS 66213-3000
(913) 221-8589
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2018024721
MO
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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