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General NPI Number Information
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NPI Number | 1003692872
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Entity Type | Individual
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Provider Name | SHELBY WILKES OD
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Gender | Female
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 1008 SOUTHMORE AVE STE 120
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City | PASADENA
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State | TX
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Zip | 77502-1202
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Country | US
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Telephone | 713-821-3091
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Fax |
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Provider Business Mailing Address
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Address Line | 3272 BELMOR XING
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-6469
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10960
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License Number State | TX
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