Provider Demographics
NPI:1215915590
Name:FARR, SHANNON BELINDA (OD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:BELINDA
Last Name:FARR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HOSPITAL DRIVE
Mailing Address - Street 2:SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-463-4086
Mailing Address - Fax:907-463-6618
Practice Address - Street 1:HARBOR VIEW EYE CARE, LLC.
Practice Address - Street 2:743 BROADWAY
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-799-3031
Practice Address - Fax:207-799-9005
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-09-15
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-12-13
Provider Licenses
StateLicense IDTaxonomies
PA0ET009051152W00000X
PAOE007953P152W00000X
AK264152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD52481Medicaid