Individual
SHANA THEDFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RO
Contact information
Practice address
3304 8TH ST, MERIDIAN, MS 39301-4755
(844) 225-7160
(386) 343-7195
Mailing address
3220 LAUDERDALE RD, LAUDERDALE, MS 39335-9639
(601) 616-1210
(601) 483-7983
Taxonomy
Speciality
Code
Description
License number
State
156FC0800X
Contact Lens Technician/Technologist
—
MS
156FX1101X
Ophthalmic Assistant
—
MS
156FX1101X
Ophthalmic Assistant
Primary
—
—
156FX1700X
Ocularist
—
—
156FX1800X
Optician
—
MS
156FX1800X
Optician
—
—
171400000X
Health & Wellness Coach
—
MS
251V00000X
Voluntary or Charitable Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05986512
—
MS
01
—
16999022
CERTIFIED CHILDREN'S VISION SCREENER
NC
Enumeration date
03/19/2018
Last updated
01/14/2026
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