Provider Demographics
NPI:1033321765
Name:GUILLORY, SHELLY L (OD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:L
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 GIST LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-4634
Mailing Address - Country:US
Mailing Address - Phone:337-855-4617
Mailing Address - Fax:
Practice Address - Street 1:2025 SAM'S WAY
Practice Address - Street 2:SAM'S OPTICAL
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-477-5272
Practice Address - Fax:337-477-6175
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1257-411T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist