Healthcare Provider Details

I. General information

NPI: 1548746720
Provider Name (Legal Business Name): SHELBY ROCKWELL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 MAIN ST
BUFFALO NY
14209-2102
US

IV. Provider business mailing address

1176 MAIN ST
BUFFALO NY
14209-2102
US

V. Phone/Fax

Practice location:
  • Phone: 716-881-7900
  • Fax: 716-881-4349
Mailing address:
  • Phone: 716-881-7900
  • Fax: 716-881-4349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberORT008833-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: