Healthcare Provider Details

I. General information

NPI: 1841362134
Provider Name (Legal Business Name): SHAFFER'S OPTICAL EXPRESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 HIGHWAY 11 N
ELLISVILLE MS
39437-5001
US

IV. Provider business mailing address

5205 HIGHWAY 11 N
ELLISVILLE MS
39437-5001
US

V. Phone/Fax

Practice location:
  • Phone: 601-425-9099
  • Fax: 601-425-9018
Mailing address:
  • Phone: 601-425-9099
  • Fax: 601-425-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MISS SHERRY JEAN SHAFFER
Title or Position: JR. VICE PRESIDENT
Credential:
Phone: 601-425-9099