Individual
MRS. SHANA BAILEY KOEHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
135 WILLOW LN, MCDONOUGH, GA 30253-6574
(678) 432-3039
Mailing address
2124 HIGH FALLS RD, JACKSON, GA 30233-5368
(706) 741-2609
Taxonomy
Speciality
Code
Description
License number
State
156FC0800X
Contact Lens Technician/Technologist
191721
GA
156FX1800X
Optician
Primary
LDO002616
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LDO002616
GEORGIA BOARD OF DISPENSING OPTICIANS
GA
Enumeration date
12/06/2018
Last updated
07/09/2025
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