Provider Demographics
NPI:1144223504
Name:SHELTON, BRIANA JOHNSON (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIANA
Middle Name:JOHNSON
Last Name:SHELTON
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 1:364 US 70 W
Mailing Address - Street 2:STE 4
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-6244
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:STE 4
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-6244
Practice Address - Country:US
Practice Address - Phone:828-652-1020
Practice Address - Fax:828-652-8302
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
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 - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093NGMedicaid
NC2473002AMedicare PIN
NC89093NGMedicaid