Provider Demographics
NPI:1215323464
Name:JANKOWSKI, SHANNON SOPER (OD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:SOPER
Last Name:JANKOWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1405 SE 164TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9644
Mailing Address - Country:US
Mailing Address - Phone:360-253-4405
Mailing Address - Fax:360-823-0035
Practice Address - Street 1:1405 SE 164TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9644
Practice Address - Country:US
Practice Address - Phone:360-253-4405
Practice Address - Fax:360-823-0035
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 60666739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist