Provider Demographics
NPI:1114108891
Name:BRIANA J. SHELTON, OD, PA D/B/A PROFESSIONAL VISION CENTERS
Entity Type:Organization
Organization Name:BRIANA J. SHELTON, OD, PA D/B/A PROFESSIONAL VISION CENTERS
Other - Org Name:PROFESSIONAL VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-652-1020
Mailing Address - Street 1:364 US 70 W
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-6243
Mailing Address - Country:US
Mailing Address - Phone:828-652-1020
Mailing Address - Fax:828-652-8302
Practice Address - Street 1:364 US 70 W
Practice Address - Street 2:SUITE 4
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-6243
Practice Address - Country:US
Practice Address - Phone:828-652-1020
Practice Address - Fax:828-652-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1837152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1837OtherTRICARE
2335795OtherMEDICARE GROUP
NC89093NGMedicaid
NCP00105772OtherMEDICARE RR
NC093NGOtherBCBS NC
NCP00105772OtherMEDICARE RR
NC89093NGMedicaid
2473002AMedicare PIN