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Individual

DR. SHANNON JESSICA MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
528 WATERLOO RD, WARRENTON, VA 20186-3011
(540) 347-0555
(540) 347-9198
Mailing address
528 WATERLOO RD, WARRENTON, VA 20186-3011
(571) 276-0237
(540) 347-9198

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
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