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General NPI Number Information
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NPI Number | 1285732453
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Entity Type | Organization
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Legal Business Name | SHELBY EYE CENTERS, P.A.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 1170 WYKE RD
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City | SHELBY
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State | NC
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Zip | 28150-4259
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Country | US
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Telephone | 704-482-6767
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Fax | 704-600-6232
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Provider Business Mailing Address
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Address Line | 1170 WYKE RD
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City | SHELBY
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State | NC
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Zip | 28150-4259
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Country | US
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Telephone | 704-482-6767
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Fax | 704-600-6232
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Authorized Official
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Title or Position | PHYSICIAN / VICE PRESIDENT
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Name | NANCY ELLEN CLINE
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Credential | MD
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Telephone | 704-482-6767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 200001408204
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License Number State | NC
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