MEDICARE: SHATLEH OPTOMETRY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1265209282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHATLEH OPTOMETRY, PLLC

Provider Business Mailing Address
First Line	:	19804 HIGHWAY 6 STE 120
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-4087
Country	:	US
Telephone Number	:	346-338-4544
Fax Number	:	346-338-4581

Provider Business Practice Location Address
First Line	:	19804 HIGHWAY 6 STE 120
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-4087
Country	:	US
Telephone Number	:	346-338-4544
Fax Number	:	346-338-4581

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. NICOLA SHATLEH
Credential	:	OD
Telephone Number	:	346-338-4581

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	03/10/2026

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