Individual
MR. SHANE S OBRIEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
21 S CHURCH ST, QUARRYVILLE, PA 17566-1213
(717) 786-4277
(717) 786-7624
Mailing address
PO BOX 487, 21 S CHURCH STREET, QUARRYVILLE, PA 17566-0487
(717) 786-4277
(717) 786-7624
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000950
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5011840001
DURA MED EQUIP
—
01
—
P0005900
RR MEDICARE
—
Enumeration date
09/07/2005
Last updated
07/08/2007
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