Shannon L Clark O D P a

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

OPC 0003067 Issued in FL

Legal business name

SHANNON L CLARK O D P A

Practice address

2305 Oleander Blvd
Fort Pierce, FL 34982-5830

Phone

(772) 465-6616

NPI assigned

Dec 26, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Shannon L W Clark Leitenbauer, O.D.

Title

President/Owner

Phone

(772) 465-6616

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1770767733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 OLEANDER BLVD",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349825830",
            "telephone_number": "772-465-6616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 OLEANDER BLVD",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349825830",
            "telephone_number": "772-465-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANNON L CLARK O D P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-26",
        "last_updated": "2008-07-29",
        "status": "A",
        "authorized_official_last_name": "CLARK LEITENBAUER",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "L W",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "772-465-6616",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "FL",
            "license": "OPC 0003067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chintan B Shah, MD
• Darshan N Shah, MD
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• Liaquddin Shaikh, M.D.
• Monique Shamoon, MD
• Shapiro Family Dentistry of Fort Pierce PA
• Babar Shareef, M.D.
• Humayun Shareef, MD DO
• Sharing Facility
• Sharing Facility Inc.

• Eyewear Supplier in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• Eyewear Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; 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.