Healthcare Provider Details

I. General information

NPI: 1043610967
Provider Name (Legal Business Name): SHIRLEY EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 RUSTIC LODGE RD
INDIANA PA
15701-3472
US

IV. Provider business mailing address

241 RUSTIC LODGE RD
INDIANA PA
15701-3472
US

V. Phone/Fax

Practice location:
  • Phone: 724-463-8882
  • Fax: 724-465-8550
Mailing address:
  • Phone: 724-463-8882
  • Fax: 724-465-8550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002899
License Number StatePA

VIII. Authorized Official

Name: DR. MATTHEW PAUL SHIRLEY
Title or Position: DOCTOR OF OPTOMETRY
Credential: O.D.
Phone: 724-859-3378