Individual
DR. SHANNON JESSICA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001510
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11505363
UHC
VA
01
—
187369
ANTHEM BCBS
VA
01
—
2140911
MAMSI
VA
01
—
3991583
AETNA
VA
Enumeration date
04/24/2006
Last updated
04/06/2018
Update your record
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