NPIMap

Organization Active NPI

Shannon R. Chandler, Corp

  • Optometrist
  • Las Vegas, NV
National Provider Identifier
1194890673
Registry record updated Mar 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
455 Issued in NV
Legal business name
SHANNON R. CHANDLER, CORP
Practice address
3962 Blue Diamond Rd Ste 105
Las Vegas, NV 89139-7795
Phone
(702) 791-6068
Fax
(702) 791-7028
NPI assigned
Nov 21, 2006
Last updated
Mar 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Shannon R. Chandler, O.D.NPI 1043385511
Title
Owner
Phone
(702) 791-6860

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 455 NV Primary

Addresses

Primary practice location

3962 Blue Diamond Rd Ste 105
Las Vegas, NV 89139-7795

Mailing address

3962 Blue Diamond Rd Ste 105
Las Vegas, NV 89139-7795
Phone (702) 791-6860

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070426000295 NV Part B Supplier - Clinic/Group Practice 8628174364 Receives reassigned benefits from 6 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

3962 Blue Diamond Rd
Ste 105
Las Vegas, NV 89139
Phone (702) 260-4127

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1194890673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3962 BLUE DIAMOND RD STE 105",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891397795",
            "telephone_number": "702-791-6860",
            "fax_number": "702-791-7028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3962 BLUE DIAMOND RD STE 105",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891397795",
            "telephone_number": "702-791-6068",
            "fax_number": "702-791-7028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNON R. CHANDLER, CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2019-03-28",
        "status": "A",
        "authorized_official_last_name": "CHANDLER",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-791-6860",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NV",
            "license": "455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.