MEDICARE: JERVEY EYE GROUP, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CN1548	OTHER	SC	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538139803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERVEY EYE GROUP, PA

Provider Business Mailing Address
First Line	:	601 HALTON RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-3403
Country	:	US
Telephone Number	:	864-250-6487
Fax Number	:	864-250-6475

Provider Business Practice Location Address
First Line	:	5 STEVENS ST STE 100
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4528
Country	:	US
Telephone Number	:	864-250-6487
Fax Number	:	864-250-6475

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	BRIAN WELLS SHELLEY
Credential	:	MD
Telephone Number	:	864-250-6487

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	09/14/2023

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Directions to “JERVEY EYE GROUP, PA ” Practice Location

Language	Start Address	Practice Location

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