Provider Demographics
NPI:1487622932
Name:MAY, SHANNA F (OD)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:F
Last Name:MAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:F
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:97 OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-3081
Mailing Address - Country:US
Mailing Address - Phone:334-566-7172
Mailing Address - Fax:334-566-7121
Practice Address - Street 1:97 OAK PARK DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36079-3081
Practice Address - Country:US
Practice Address - Phone:334-566-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-853-TA-409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051532603OtherB/C PROVIDER #
AL009935191Medicaid
AL009935191Medicaid
ALP00314449Medicare PIN
AL051532603Medicare PIN