Individual
DR. KELLY SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1597 SW 53RD ST, CORVALLIS, OR 97333-2630
(541) 757-8844
(541) 754-9810
Mailing address
1597 SW 53RD ST, CORVALLIS, OR 97333-2630
(541) 757-8844
(541) 754-9810
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4059AT
OR
Other
Enumeration date
08/22/2016
Last updated
08/22/2016
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