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General NPI Number Information
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NPI Number | 1700166683
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Entity Type | Organization
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Legal Business Name | SHELTON EYECARE INC
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/23/2011
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Provider Practice Location Address
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Address Line | 231 WESTWOOD DR
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City | LEXINGTON
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State | TN
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Zip | 38351-1417
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Country | US
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Telephone | 270-705-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 231 WESTWOOD DR
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City | LEXINGTON
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State | TN
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Zip | 38351-1417
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Country | US
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Telephone | 270-705-7777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN ROSS SHELTON
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Credential | OD
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Telephone | 270-705-7777
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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 | OD2904
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License Number State | TN
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