Basic Information
| Provider Information | |||||||||
| NPI: | 1285066720 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHANNON S. SUH, O.D., PA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8801 OHIO DR | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750242268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727318677 | ||||||||
| FaxNumber: | 9727318635 | ||||||||
| Practice Location | |||||||||
| Address1: | 8801 OHIO DR | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750242268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727318677 | ||||||||
| FaxNumber: | 9727318635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2013 | ||||||||
| LastUpdateDate: | 09/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | SUH | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
| AuthorizedOfficialMiddleName: | SUMI | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9727318677 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | O.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5808T | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 919792 | 01 | TX | BLOCKVISION | OTHER | 0018FF | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |