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General NPI Number Information
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NPI Number | 1598972077
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Entity Type | Organization
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Legal Business Name | SHETTLE OPTICAL SOLUTIONS,INC.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/03/2009
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Provider Practice Location Address
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Address Line | 670 CLEARWATER LARGO RD N STE B
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City | LARGO
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State | FL
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Zip | 33770-2377
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Country | US
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Telephone | 727-586-1260
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Fax | 727-586-3636
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Provider Business Mailing Address
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Address Line | 670 CLEARWATER LARGO RD N STE B
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City | LARGO
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State | FL
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Zip | 33770-2377
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Country | US
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Telephone | 727-586-1260
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Fax | 727-586-3636
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Authorized Official
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Title or Position | OPTICIAN
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Name | MRS. DIANA MARIE SHETTLE
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Credential | L.D.O.
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Telephone | 727-586-1260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OPC3278
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License Number State | FL
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