Provider Demographics
NPI:1154055069
Name:SHELL, SARAH JORDAN COLLINS (OD)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JORDAN COLLINS
Last Name:SHELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:JORDAN
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 SOUTH BELLS STREET
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001
Mailing Address - Country:US
Mailing Address - Phone:731-696-4004
Mailing Address - Fax:731-696-4009
Practice Address - Street 1:135 SOUTH BELLS STREET
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001
Practice Address - Country:US
Practice Address - Phone:731-696-4004
Practice Address - Fax:731-696-4009
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3736152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist