MEDICARE: MR. THOMAS JEFFERSON SCHELL O.D.

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	6242258-9934	UT

General Provider Information

NPI Number	:	1669406187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS JEFFERSON SCHELL O.D.

Provider Business Mailing Address
First Line	:	953 E 1420 N
Second Line	:
City	:	AMERICAN FORK
State	:	UT
Zip	:	84003-8856
Country	:	US
Telephone Number	:	801-809-5841
Fax Number	:

Provider Business Practice Location Address
First Line	:	4314 KEMP BLVD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-3716
Country	:	US
Telephone Number	:	940-691-5645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	11/05/2013

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