Shannon Marie Evans, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC 4704 Issued in FL

Practice address

1711 NE 163Rd St
North Miami Beach, FL 33162-4732

Phone

(302) 670-4096

Fax

(305) 949-0703

NPI assigned

Aug 21, 2012

Last updated

Sep 18, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: shanna.evans.p1@direct.caremax.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• 305 Vision

  • Optometrist
  • Pinecrest, FL
  • NPI 1508419011
  NPD Authorized official
• Evans Eye Care Corp

  • Optometrist
  • North Miami Beach, FL
  • NPI 1255815064
  Authorized official Same address or phone

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

{
    "created_epoch": "1345507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1205184488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 NW 207TH TER",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330293506",
            "telephone_number": "302-670-4096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 NE 163RD ST",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331624732",
            "telephone_number": "302-670-4096",
            "fax_number": "305-949-0703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-21",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 4704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014059500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eureka Chiropractic Center, LLC
• Tynesha L Eutsay
• Evan Mehlman PHD P.a.
• Wayne Nicholas Evancho, DO
• Evans Eye Care Corp
• Executive Medical Group LLC
• Executive Medical Physics Associates, LLC
• Exelsior Diagnostic Service, Inc.
• Exelsior Medical Group, Inc.
• Express Vision Care, Inc.

• Optometrist in North Miami Beach, FL
• Providers in North Miami Beach, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.