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General NPI Number Information
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NPI Number | 1861477051
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Entity Type | Organization
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Legal Business Name | SHELL OPTICAL OF VIRGINIA, INC.
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2463 PRUDEN BLVD
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City | SUFFOLK
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State | VA
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Zip | 23434-4235
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Country | US
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Telephone | 757-934-2422
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Fax | 757-934-2640
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Provider Business Mailing Address
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Address Line | 2463 PRUDEN BLVD
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City | SUFFOLK
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State | VA
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Zip | 23434-4235
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Country | US
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Telephone | 757-934-2422
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Fax | 757-934-2640
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. GERALD W SHELL
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Credential | ABOC
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Telephone | 757-934-2422
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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 | 1101001778
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1101000541
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License Number State | VA
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