Evans, Shannon Marie
Evans, Shannon Marie is an sole proprietor health care provider with primary practice located at 1711 Ne 163Rd St , North Miami Beach FL 33162-4732. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Evans, Shannon Marie can be contacted via phone (302) 670-4096.Contact Information
Primary practice address
1711 Ne 163Rd St
North Miami Beach FL 33162-4732
Phone: (302) 670-4096
Fax: (305) 949-0703
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OPC 4704 | Florida |
Profile Details
| NPI number | 1205184488 |
|---|---|
| LBN Legal business name | Evans, Shannon Marie |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 21st, 2012 |
| Last updated | Sep 18th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205184488 | NPPES |
| Florida | MEDICAID | 014059500 |
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