Provider Demographics
NPI:1407602634
Name:CONNOR, SHANNON KRISTI (OD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:KRISTI
Last Name:CONNOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7700 W ARROWHEAD TOWNE CTR STE 2130
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0929
Mailing Address - Country:US
Mailing Address - Phone:602-571-8669
Mailing Address - Fax:
Practice Address - Street 1:2020 E RIO SALADO PKWY # 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85288-3042
Practice Address - Country:US
Practice Address - Phone:480-967-0563
Practice Address - Fax:480-967-0563
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist