Individual provider · NPI-1

Shannen Leigh Didyk

Technician/Technologist, Optician · Tucson, AZ

NPI number1336824101
StatusActive
Last updated in NPPESJun 20, 2023

Details

NPI
1336824101
Entity type
Individual (NPI-1)
Name
Shannen Leigh Didyk
Sex
Female
Sole proprietor
Yes
Enumeration date
Jun 20, 2023
Certification date
Jun 20, 2023
Last updated
Jun 20, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
156FX1800X Technician/Technologist, Optician002397AZYes

Practice location

1220 W Giaconda Way
Tucson, AZ 85704-3013

Phone 520-744-6721

Mailing address

1220 W Giaconda Way
Tucson, AZ 85704-3013

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