=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992923171
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAPPLEY EYE CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2007
-----------------------------------------------------
Last Update Date | 02/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 804 CHILDS ST
-----------------------------------------------------
City | CORINTH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38834-4933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-286-6171
-----------------------------------------------------
Fax | 662-287-3937
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 804 CHILDS ST
-----------------------------------------------------
City | CORINTH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38834-4933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-286-6171
-----------------------------------------------------
Fax | 662-287-3937
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER-MANAGER
-----------------------------------------------------
Name | DR. ROBERT W SHAPPLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-286-6171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 542
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------