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General NPI Number Information
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NPI Number | 1922351337
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Entity Type | Organization
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Legal Business Name | SHELTON O.D. PC
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4812 VALLEY VIEW BLVD NW
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City | ROANOKE
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State | VA
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Zip | 24012-2018
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Country | US
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Telephone | 540-362-8855
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Fax |
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Provider Business Mailing Address
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Address Line | 501 GREEN ST
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City | BLACKSBURG
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State | VA
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Zip | 24060-4662
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Country | US
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Telephone | 540-818-1827
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY CHARLES SHELTON
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Credential | O.D.
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Telephone | 540-818-1827
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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 |
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License Number State |
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