Individual
SHANE THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1717 W. CHANDLER BLVD, CHANDLER, AZ 85224
(480) 821-7565
(480) 821-4303
Mailing address
25500 N. NORTERRA PARKWAY, BLDG B, PHOENIX, AZ 85085
(623) 277-1000
(602) 906-2789
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1521
AZ
Other
Enumeration date
07/09/2006
Last updated
03/04/2014
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