Individual
SHANE R KANNARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2521 N BROADWAY ST, PITTSBURG, KS 66762-2620
(620) 235-1737
(620) 230-0358
Mailing address
101 W 29TH ST, SUITE G, PITTSBURG, KS 66762-2696
(620) 235-1737
(620) 230-0358
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1699
KS
152W00000X
Optometrist
2000160785
MO
152W00000X
Optometrist
2544
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20036611OD
—
KS
Enumeration date
12/27/2005
Last updated
05/09/2012
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